My doctor once breezily suggested I go on a statin after my LDL, the “bad cholesterol,” spiked several years ago.
“It’s just a matter of time,” he said, “before they put statins in the water supply.”
His half-joke reflected an optimism about cholesterol-lowering drugs that’s made them so popular. If you’re over 40, there’s about a 30 percent chance you’re on a statin. If you’re over 65, it’s nearly 50 percent.
A 2011 study showed at least 32 million Americans are on a statin, and under 2013 guidelines issued by the American Heart Association and the American College of Cardiology, another 24 million or so Americans should probably be on one — Crestor, Lipitor, Zocor, among others — to help prevent heart attacks and heart disease.
But while nearly all experts agree that statins are beneficial for people at a substantial risk for heart disease, some medical researchers argue that statins do little or no good — and possible harm — for people at lower risk of heart disease. The conflict has burst into public view in the United Kingdom — and is likely heading here, too.
A bruising battle has played out for several years between Britain’s two leading medical research journals, the Lancet and the British Medical Journal (BMJ), which have accused each other of endangering public health. The debate has gotten so heated that it has made tabloid headlines (“STATIN WAR,” blasted the Daily Mail). It began when BMJ first questioned statins’ usefulness in 2014, publishing two articles that argued that the drug was being overprescribed to people with low risk of heart disease. It also claimed that the side effects from the drugs were worse than previously thought.
A furor ensued.
An eminent statin expert at Oxford University, Rory Collins, called on BMJ to retract the articles — retraction is a mark of shame in science circles — arguing their influence “would lead to unnecessary heart attacks and strokes.”
An independent panel brought in by BMJ said the journal didn’t need to retract, though the journal did issue a correction about the drugs’ side effects, saying it had misread key data.
Last month, Collins published his own 30-page defense of statins in the Lancet, BMJ’s main competitor. The Lancet’s editor, Richard Horton, contributed a pointed editorial that blasted “disputed research and tendentious opinions,” presumably from BMJ, which he claimed “caused measurable harm to public health.”
A week later, BMJ Editor Fiona Godlee fired back, asking England’s chief medical officer, Sally Davies, to create an independent review of the evidence for statins, saying it was the only way “an increasingly bitter and unproductive dispute is to be resolved.”
The dispute is more subdued but just as urgent in the United States.
“It may not be in the press, but it is in the professional community,” according to Rita Redberg, a cardiologist at the University of California in San Francisco, and the editor of one of the major medical journals in the United States, JAMA Internal Medicine.
Redberg has been a prominent critic of the existing guidelines, which she believes lead to overuse among people with low risk of heart disease who won’t see any measurable benefits from taking a statin. She also said that she and “a small group of authors” were working on a response to the Lancet article.
She said many of those at low risk who take statins may suffer the drugs’ side effects unnecessarily. These problems potentially include muscle pain, increased risk of diabetes (especially for women), slowed cognitive function, cataracts and sexual dysfunction.
“You see patients every week who complain about how miserable they feel because they were on statins, but have been put on them by doctors,” Redberg said.
To Collins, negative side effects of statins are real — but also exceedingly rare, according to his study. He also points out that most side effects will go away with either a lower dosage or switching to a different statin.
"It’s a force for good, and to characterize it as otherwise is a bit perverse," he said.
Simply raising concerns about statins freaks out their staunchest advocates, who worry that the message will drive people away from the drugs who need them most.
The BMJ discovered as much this year in a study of statin use in Britain after its own critical reports were published. “Patients already taking statins were more likely to stop taking them for both primary and secondary prevention after [a] high media coverage period,” the report stated, suggesting that could translate to between 2,000 and 6,000 heart attacks or “cardiovascular events” in the next 10 years.
So a reminder: Don’t stop taking a statin after reading this article, at least not before consulting your doctor. Statins clearly save lives.
The key is to consider ongoing research about statins “an ongoing discussion,” said Nieca Goldberg, a cardiologist and medical director of NYU Langone's Joan H. Tisch Center for Women's Health. “I think people get confused,” Goldberg said. “Patients will sometimes say, ‘why don’t you guys make your minds up?’ ”
When I was prescribed a statin, I instead opted for a grace period to try lowering my bad cholesterol level, and after a few months of more diligent exercise and a more plant-based diet, my numbers dropped well below the danger limit.
That’s why Redberg thinks cholesterol is often a “misguided” focus. “If we’d focus on overall risk — and on improving diet and physical activity — I think we’d be more healthy,” she says.
Some research even suggests that those who opt for a statin stop worrying much about their diets. A 2014 report in JAMA Internal Medicine, looking at roughly 28,000 adults from 1999 to 2010, showed that “caloric and fat intake have increased among statin users over time, which was not true for nonusers.”
So had I chosen that statin, I might’ve felt safer from a heart attack. Maybe a little too safe.