Statins - Analysing the Media Hype
Statins are the most widely prescribed drugs in the world today, which means the next time you visit your doctor, depending on your symptoms, he may very well discuss them with you. However, if you read the tsunami of scientific research on statins, these drugs are surrounded by controversy with some studies hailing them as life-savers and others warning against their use. The very week I prepare to write this blog, articles appear in mainstream media throughout the UK, warning that “thousands of Britons are dying from heart attacks and strokes after being scared off statins by warnings of non-existent side effects.”1
If you are one of many, now considering rushing to your GP to get a prescription for a statin drug, fearing that, having been 'scared off' statins yourself, you are going to join the thousands of Britons who are dying, I am going to attempt to clarify the media hype for you.
One thing is certain about statins: for every drop of scientific evidence that statins are safe and effective, there is a deluge of evidence that warns of their side effects.
One thing is certain about statins: for every drop of scientific evidence that statins are safe and effective, there is a deluge of evidence that warns of their side effects. London cardiologist Dr Aseem Malhotra goes as far as saying “I fear the misrepresentation of research on statins – both in terms of benefits and harms – will be one of the biggest cons and scandals in the history of medicine.”
Let’s consider one headline this week - “False scare on statins causes thousands to die.” Statements like this imply that thousands of Britons are dying because they are not on a statin. Yet we know from numerous recent scientific studies that over 50% of heart attacks are not related to cholesterol levels. We also know that there are numerous other independent risk factors implicated in heart disease, such as diabetes and pre-diabetes, 1 metabolic syndrome, 2 low levels of serum cholesterol in the elderly, 3 elevated homocysteine 4 and obesity. 5 So, is there any proof that these deaths are caused by a failure to take a statin drug?
The quoted statements in the media this week are based on the findings of a major study conducted over three years, looking at lowering cholesterol in more than ten thousand patients in the UK, Ireland and the Nordic regions. This study found that patients who were told they were taking a statin reported more side effects than when they were not told they were on the drug. In light of the evidence of the side effects of statins that has accumulated over the past decades, it is difficult to understand how the finding of this study has led to the assertion that there are “non-existent side effects,” to taking statins. This reference to “non-existent side effects” is an example, I believe, of what Dr Malhotra is referring to when he says “I fear the misrepresentation of research on statins …” There is a huge amount of scientific evidence on the side-effects of statin use and it is ever-increasing. Click here to access 514 abstracts of research on statin induced pathologies.
More important still, is the evidence from patients who, having experienced one or more side effects whilst taking statins, report feeling better as soon as they stop. The main author of the study, quoted at the top of this article, which was published in The Lancet, attributes these side effects to ‘the nocebo effect,’ i.e “the symptoms of muscle pain and weakness are not caused by the drugs themselves … but are a psychosomatic response,” he explains. Many patients who suffer, or have suffered, the debilitating side effects of statin drugs will beg to differ. In fact, in an article in theWorld Journal of Cardiology, entitled “Cholesterol Confusion and Statin Controversy,” the point is made that in “the largest statin survey ever conducted, the National Lipid Association observed that roughly 30% of statin patients reported experiencing muscle pain and weakness and 57% of surveyed patients reported stopping the drug due to side effects. 6 This article goes on to point out that the “incidence of muscular aches and weakness in statin trials is highly variable, and real world experiences may differ from clinical trial reports.” This may very well explain the nocebo effect reported by the author of this study.
The 2015 article in the World Journal of Cardiology evaluated numerous studies on cholesterol and statins, stating that the role of blood cholesterol levels in coronary heart disease (CHD) and the true effect of cholesterol-lowering statin drugs are debateable. In particular, whether statins actually decrease cardiac mortality and increase life expectancy is controversial. Currently the Mediterranean diet model has been shown to prolong life and reduce the risk of diabetes, cancer and CHD. This article states that early statin trials have been flawed, mortality benefits of statins are inconsistent, statin drugs have unintended consequences, and concludes that “the global prevalence of CHD, despite worldwide statin usage and cholesterol lowering campaigns, has reached pandemic proportions.”
What I find most concerning is that, despite the growing evidence that cholesterol is not the primary cause of heart disease, the pharmaceutical industry is still aggressively marketing statins.
Coronary heart disease is an extremely complex malady and the expectation that it could be prevented or eliminated by simply reducing cholesterol, appears unfounded. It is time to concede the anomalies of the cholesterol hypothesis and refocus our efforts on the proven benefits of a healthy lifestyle, incorporating a Mediterranean style diet, to prevent CHD. This study has been published in The Lancet and was funded by the drug firm, Pfizer, which manufactures statins. Previous related studies in The Lancet have ellicited headlines such as “Lancet study on statins was fundamentally flawed,” “ Statins: Flawed Studies, False Advertising and Lack of Transparency” and “Statin side effects are more troubling than a new paper admits.” I suspect it will not be long before possible flaws in this study are debated. What I find most concerning is that, despite the growing evidence that cholesterol is not the primary cause of heart disease, the pharmaceutical industry is still aggressively marketing statins.
For a more in-depth understanding of the role and function of statins, please take a look at my article, 'Understanding Statins, Cholesterol and Heart Disease'.
1 Kilmer G, Hughes E, Zhang X, Elam-Evans L (2011) Diabetes and prediabetes: screening and prevalence among adults with coronary heart disease. American Journal of Preventative Medicine 40(2): 159-165.