Statin-type cholesterol-lowering drugs have been controversial for decades. Atorvastatin (Lipitor), lovastatin (Mevacor), rosuvastatin (Crestor), simvastatin (Zocor) and similar meds have made tens of billions of dollars for their manufacturers. How good are such drugs at saving lives? Is stopping statins a “threat to public health?”
The Polarization of Medicine:
Many Americans are distressed about the current level of polarization in politics. What they might not realize is that certain topics in medicine have also become quite polarized.
The Statin Enthusiasts:
One such is statin treatment for elevated cholesterol levels. Many cardiologists are adamant that statins are crucial for protecting people from heart attacks and strokes.
Some have stated, almost seriously, that statins are so beneficial that they should be put in the water supply. They maintain that side effects are relatively rare and usually mild for most patients. Stopping statins, even if someone is experiencing muscle pain or weakness, is considered counterproductive to heart health.
Recommendations from the American Heart Association and the American College of Cardiology would require that 97 percent of Americans between 66 and 75 be taking statins (JAMA Internal Medicine, Jan. 2015).
The Statin Skeptics:
Other cardiologists, however, point out that statin benefits are modest. Dr. Robert Dubroff and Dr. Michel de Lorgeril writing in the World Journal of Cardiology (July 26, 2015) note that a number of key statin studies have failed to demonstrate a mortality benefit from such drugs.
An analysis of all randomized controlled trials involving a statin vs. placebo (BMJ Open, Sept. 24, 2015) concluded:
“The survival gains we found are surprisingly small. The highest value was 27 days, found in the 4S study, achieved by 5.8 years of simvastatin therapy in participants with a history of unstable angina or myocardial infarction [heart attack].”
The authors also noted that after years of statin treatment:
“The median postponement of death for primary and secondary prevention trials were 3.2 and 4.1 days, respectively.”
Cardiologists Dubroff and de Lorgeril pointed out in their article that statin side effects may be more common and more serious than clinical trials indicate. Some observational studies report adverse reaction rates of 20 percent, which leads to stopping statins (Annals of Internal Medicine, July 25, 2017).
Statin Skirmish Turns into Open Warfare:
The latest salvo in the statin wars appears in the pages of the Annals of Internal Medicine (July 25, 2017). A retrospective study evaluated the health of 28,255 patients seen at Brigham and Women’s Hospital or Massachusetts General Hospital in Boston.
All of these individuals had an adverse reaction to a statin cholesterol-lowering drug documented in their electronic medical record. Some of these people stopped taking the medication, although the majority continued on a statin.
Four years later, the researchers determined that 12.2 percent of those on a statin had experienced a heart attack, stroke or death from any cause. In comparison, 13.9 percent of those who had discontinued their statin met such a fate. The difference between the two groups is 1.7 percent.
Some cardiologists see this as a huge benefit. Others maintain that it is modest at best. The authors of this study state: “Continued use of statins after an adverse reaction may not be the optimal choice for everyone.”
Dr. Steve Nissen Goes After Statin Skeptics:
An editorial in the same issue of the Annals of Internal Medicine declares:
An Internet-Driven Cult with Deadly Consequences”
Editorialist Dr. Steve Nissen of the Cleveland Clinic notes:
“Statins have developed a bad reputation with the public, a phenomenon driven largely by proliferation on the Internet of bizarre and unscientific but seemingly persuasive criticism of these drugs.”
He points out that:
“discontinuing statin treatment may be a life-threatening mistake.”
Dr. Nissen is very unhappy that more people are not taking statins. He argues that:
“56 million Americans are considered eligible for statin therapy, with about half actually receiving treatment.”
Dr. Nissen bemoans the fact that:
“We are losing the battle for the hearts and minds of our patients to Web sites developed by people with little or no scientific expertise, who often pedal ‘natural’ or ‘drug-free’ remedies for elevated cholesterol levels.”
It is Dr. Nissen’s opinion that if patients are stopping statins, a staggering number will die. He states that “statin discontinuation or non adherence has grave consequences.” He specifically targets what he calls “fad diets” that “offer patients the promise of nearly miraculous reversal of heart disease by dietary means.”
“In many cases, the advocates aggressively promote their dietary approach as an alternative to statins, promising all of the benefits with none of the risks.”
Dr. Nissen calls upon “thoughtful physicians” to counter these dangerous cults by explaining to our patients that:
“discontinuing statin treatment may be a life-threatening mistake.”
Who Are The “Cultists”?
Dr. Oz comes in for specific criticism in Dr. Nissen’s editorial. Although not specifically named, three prominent cardiologists may also be in Dr. Nissen’s crosshairs:
Rita Redberg, MD, MSc, is Professor of Medicine at the University of California, San Francisco, and Director of the UCSF Women’s Cardiovascular Center. She is editor of one of the world’s pre-eminent medical journals, JAMA Internal Medicine.
Pascal Meier, MD, is an interventional cardiologist at University Hospital Geneva and The Heart Hospital, University College London Hospitals. He is Editor-In-Chief of Open Heart (BMJ), associate editor of the BMJ (British Medical Journal) and associate editor of the Cochrane Heart Group.
Aseem Malhotra, MD, is consultant cardiologist at London’s Lister hospital and at the Frimley Health NHS Foundation Trust.
These highly regarded cardiologists wrote an editorial in the British Journal of Sports Medicine (April 25, 2017).
The title of their article:
“Saturated fat does not clog the arteries:
coronary heart disease is a chronic inflammatory condition, the risk of which can be effectively reduced from healthy lifestyle interventions”
The editorial in the British Journal of Sports Medicine emphasized that a Mediterranean diet reduced heart attacks and deaths dramatically even though it did not lower LDL cholesterol. The cardiologists concluded:
“It is the alpha linoleic acid, polyphenols and omega-3 fatty acids present in nuts, extra virgin olive oil, vegetables and oily fish that rapidly attenuate inflammation and coronary thrombosis.”
They go on to pin the tail on insulin resistance. These cardiologists suggest that chronically elevated insulin levels are “at the root of heart disease, type 2 diabetes and obesity.” Instead of worrying about LDL cholesterol, they say we should be “replacing refined carbohydrates with healthy high fat foods.”
Exercise is also central to their program. They point out that “30 min of moderate activity a day more than three times/week” lowers insulin resistance.
We do not believe that Dr. Nissen is really calling these cardiologists cultists. He has stated directly to us on the radio that a healthy lifestyle is essential for heart health and he has himself recommended a Mediterranean-type diet.
The Statin Skirmish Has Turned Ugly:
Like many Americans we are saddened that there is such polarization in politics. To see this kind of divisiveness spill over into medicine is even more disheartening.
The statin enthusiasts insist that stopping statins will lead to a large number of deaths. They downplay side effects.
The statin skeptics maintain that statins barely make a dent in mortality statistics. They point out that statin side effects such as muscle pain and weakness may limit exercise, which is essential for heart health and overall well being. They also note that statins may increase blood sugar and can lead to diabetes, which in itself contributes to heart disease.
It is no wonder that patients are confused. When highly credentialed cardiologists cannot agree about statins or diet it leaves the rest of us in the lurch.
Decide For Yourself:
If you would like to listen to Dr. Steve Nissen and Dr. Rita Redberg discuss these very issues on The People’s Pharmacy syndicated radio show, here is a link to a one-hour interview we conducted with both of these prominent cardiologists. Click on the green arrow inside the black circle above the plastic heart for free streaming audio. Make up your own mind based on the evidence they present.
Express your own opinion below in the comment section. Please be respectful of different opinions.