Statins

Ann Marie Navar, MD, PhD on the “Anti-Statin” Movement: Untangling the Web of Misinformation

Vocal groups opposed to traditional Western medicine have continued to take aim at proven treatments and interventions for years, especially since the 1998 publication and subsequent retraction of Andrew Wakefield’s long-disproven paper, which falsely linked vaccination to autism spectrum disorder.1

In the years that followed, statin therapy also became one of many targets for false medical information. Unreliable websites and similar sources have falsely linked statins to adverse effects such as memory loss and cancer, said Ann Marie Navar, MD, PhD, associate professor of cardiology at UT Southwestern in Dallas, Texas and associate editor of JAMA Cardiology.1

The medical community is uniquely positioned to help combat the spread of medical misinformation about statins and other interventions on the Internet, Dr Navar says. Consultant360 spoke with her further about common statin-related myths, reassuring patients of the safety of statin therapy, and reliable sources of information for patients.

Consultant360: What are the top myths about statins that are circulating among patients and on the Internet? What consequences have resulted from this?

Dr Navar: A top myth about statins is that statins cause adverse effects such as memory loss or cognitive impairment, which is not true.2 Another common myth about statins is related to the rate of statin-induced myalgia. In placebo-controlled trials, the rates of myalgia in statin-treated vs placebo-treated participants are usually nearly identical, with up to 1 in 4 participants in both treatment groups experiencing myalgia.2 Unfortunately, in real-world settings, many statin-treated patients who have arthritis, myalgia, or other body aches often falsely attribute this to their statin.3 As a result, many patients do not want to initiate a statin, or they discontinue statins due to fear of adverse effects.

In addition, the misconceptions about statins fuel a sort of negative placebo-effect, called the “nocebo effect,” which occurs when fear of adverse effects causes patients to falsely perceive that they are experiencing these effects.3 The nocebo effect is very real for those who experience this phenomenon. However, the true cause of this is the misinformation about statins, not the statin itself. 

Another common myth I encounter in my own practice is when evidence related to cholesterol is conflated with evidence related to statins. There are ways to lower low-density lipoprotein (LDL) cholesterol that do not actually impact risk of cardiovascular disease (CVD). For example, substituting different types of fats in one’s diet can lower LDL cholesterol, but not CVD risk.4 This is likely because it matters how LDL is lowered and its impact on particle composition. Just because some people with high LDL cholesterol do not develop CVD, or certain interventions that lower cholesterol do not reduce CVD, does not mean that statins are not effective.

Consultant360: What key points should health care providers always share with patients when discussing and/or prescribing a statin, especially in regard to potential adverse effects and the risk/benefit ratio of statin use?

Dr Navar: There is a real risk of statin-associated rhabdomyolysis, which impacts about 1 in 10,000 people.2 This is serious when it happens, but it is easy to identify (a blood test for creatine kinase level can detect rhabdomyolysis), and it is nearly always reversible.2 The cognitive impacts of statins are well-studied, and it has been determined that statins do not cause memory loss.2 Statins are associated with an increased risk of diabetes, though this risk appears to be limited to patients who already have an elevated risk for diabetes, such as those with obesity, prediabetes, or metabolic syndrome.2 In these patients, statins may accelerate the onset of diabetes by about 6 weeks.2

The benefits of statins are well proven: statins remain one of the most effective therapies to prevent myocardial infarction and stroke. In a patient who is free of CVD, statins have 3 times the impact of aspirin in preventing CVD.5 Not to mention, statins are cheap! All statins are available as generics, so they really should be accessible to everyone.

C360: What key actions can providers take to help reassure patients about statin safety and combat anti-statin misinformation?

Dr Navar: First, be proactive! Providers should tell patients about the actual risks of statin use so they do not think we are trying to hide anything from them. Also, I warn my patients about the amount of false information about statins on the Internet and tell them about the nocebo effect, in which people who fear adverse effects are more likely to perceive that they are actually experiencing those effects. I reassure my patients that the best data come from randomized trials with a placebo-control and explain why this is so critical.

Second, do not give up! When patients feel that they are experiencing adverse effects from their statin, this is very real to them, even if it is simply determined to be a nocebo effect. We know from great centers like the Cleveland Clinic that most people who have trouble with one statin can eventually switch to another, even if it means starting with a very low-dose, once-weekly formulation.

Finally, trust reputable sources. The American Heart Association and American College of Cardiology are good places to start, as are data from randomized trials. The Cholesterol Treatment Trialists have done great work in summarizing the data from trials. I warn patients about the amount of false news on the Internet and highlight that most of the sources peddling anti-statin information are happy to sell unregulated and untested alternatives.

C360: What key take-home message would you like to leave with health care providers?

Dr Navar: We cannot stay in our bubbles and complain to each other about the growing tide of anti-statin misinformation. Although it takes work to address this with our patients, most of our patients really want to do what is best for their health. There are some who will remain resistant regardless of what we say, but many more just need our help in navigating the cacophony of science and pseudoscience that floods their Facebook news feeds and Google searches. We cannot underestimate the power of a strong therapeutic relationship between doctor and patient. I think that, deep down, most of my patients trust me and know that I am trying to recommend what is best for their health. I may not be able to convince a doubting public who does not know me personally about the safety and efficacy of statins. However, I have been able to talk to many of my patients honestly about their fears, and many of them have ultimately decided they will try a statin, and most do quite well on statin therapy.

Ann Marie Navar, MD, PhD, is an associate professor of cardiology at UT Southwestern in Dallas, Texas, and associate editor of JAMA Cardiology.

—Christina Vogt

References:

  1. Navar AM. Fear-based medical misinformation and disease prevention: from vaccines to statins [Published online June 26, 2019]. JAMA Cardiol. doi:10.1001/jamacardio.2019.1972.
  2. Collins R, Reith C, Emberson J, et al. Interpretation of the evidence for the efficacy and safety of statin therapy. Lancet. 2016;388(10059):2532-2561. https://doi.org/10.1016/S0140-6736(16)31357-5.
  3. Pedro-Botet J, Climent E, Benaiges D. Muscle and statins: from toxicity to the nocebo effect. Expert Opinion Drug Safety. 2019;18(7):573-579. https://doi.org/10.1080/14740338.2019.1615053.
  4. Ramsden CE, Zamora D, Leelarthaepin B, et al. Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis. BMJ. 2013;346:e8707. https://doi.org/10.1136/bmj.e8707.
  5. Karmali KN, Lloyd-Jones DM, Berendsen MA, et al. Drugs for primary prevention of atherosclerotic cardiovascular disease: an overview of systematic reviews. JAMA Cardiol. 2016;1(3):341-349. doi:10.1001/jamacardio.2016.0218.