The demonisation of statins: why this important cholesterol-lowering drug doesn’t deserve the hate
A war has erupted in the medical community, on social media and in health policy over cholesterol-lowering statins, a drug taken by 2.2 million Australians. Now an eminent cardiologist explains why he thinks the anti-statin argument is nonsense.
As a cardiologist, statins are one of the most important medications I have at my disposal.
They are the most commonly prescribed drugs in Australia, with about 2.2 million of us taking a statin every day.
They are vital in lowering cholesterol and preventing heart disease – Australia’s biggest killer.
Without these medications, I have no doubt many of my patients would have suffered entirely preventable heart attacks or strokes.
But not everyone sees statins the way most cardiologists and health professionals do.
In fact, there are doctors attracting worldwide attention for their opposition to prescribing statins – including perhaps one of the highest profiles of them all, British cardiologist Dr Aseem Malhotra.
He’s just been appointed chief medical adviser of the Make America Healthy Again campaign group co-founded by President Donald Trump’s Health Secretary Robert F Kennedy Jnr, giving him an unprecedented platform.
Although I’ve seen the life-changing impact of these medications, I have noticed a growing mistrust even among my patients who are being told that the benefits of statin use are overblown and that medical institutes are in cahoots with Big Pharma.
It’s nonsense, of course, but it’s also dangerous nonsense.
Influenced by the influencers
Speak to any health professional and they’ll likely say that one of the biggest issues they face today is patients who make decisions about their medications based on something they heard on a podcast, read on the internet or in a book, or saw in a social media post.
Some of the people putting out these stories are wellness influencers without any medical background, but others have science and medical CVs stretching back decades. It’s these “experts” who worry me the most because … why wouldn’t you believe a doctor? Especially one who has just been promoted to one of the highest-profile jobs in the world, such as Dr Aseem Malhotra.
Dr Malhotra is a well-known Covid vaccine sceptic who advocates for a “statin-free life” through a focus on a healthy lifestyle. He claims their benefits have been grossly exaggerated, side-effects downplayed, and questions the independence of trials and data. He also believes death rates are only marginally reduced by taking statins.
So, does he have a point? Is there is any truth in what he, and many others, are saying?
What does the science say about their lifesaving benefits?
The first statins became available commercially in the 1980s after being isolated from the fungus penicillium citrinum in the 1970s.
Their effectiveness in reducing LDL “bad” cholesterol has made them a mainstay in the treatment of elevated cholesterol levels, which are associated with increased risk of cardiovascular disease and cardiovascular events, including heart attack and stroke.
While there is debate on the exact degree of effectiveness of statins, numerous important research papers have shown significant, consistent benefit in the reduction of cardiovascular events and mortality.
For example, a 2022 meta-analysis of 26 studies found the use of statins was associated with a significant reduction in all-cause mortality and cardiovascular events, including a 33 per cent reduction in the risk of heart attack.
Another 2021 meta-analysis of 62 randomised controlled trials found that statins reduced the incidence of heart attack by 28 per cent, stroke by 20 per cent and death due to cardiovascular causes by 17 per cent.
Some critics suggest that these numbers aren’t significant enough to warrant the use of statins. But I’ll take an almost 30 per cent reduction in heart attack risk any day, particularly when the same meta-analyses showed that the risk of severe side effects from statin use is extremely low.
Medication risk vs. medication reward
Now this is not to say that we shouldn’t be aware of the risk of any form of treatment, whether it be a drug or natural therapy. Every treatment comes with a list of potential side effects.
In the case of statins, side effects may include muscle pain and digestive problems. On the more severe but rare end they may cause changes in liver function, increased risk of type 2 diabetes, eye conditions, and more significant muscle issues.
I have seen plenty of concern over these potential side effects of statins in my patients. I get more questions about statins than any other medication – no doubt partly influenced by much of the fearmongering in the media and online.
But in reality, I’ve found that the side effects of statin use are few, severe side effects are rare, and these potential risks are vastly overweighed by the benefits of lowering cholesterol and managing cardiovascular disease risk.
And the studies back me up; the 2022 meta-analysis found statins were not significantly associated with increased risk of severe adverse events, muscle pain or decreased liver function, while the 2021 meta-analysis found them to be rare.
Of course, as with any medication, it is important that if you do experience side effects, you alert your doctor. This then allows us to monitor and change our treatment approach if necessary.
Even if you don’t experience any side effects, it’s vital that you regularly review your statin use with your doctor.
Inaction comes with its own risks
There’s another aspect of risk that we tend to overlook; that is the risk associated with inaction – ie, not doing anything, or more specifically not taking medications to lower cholesterol when they are indicated.
If cholesterol isn’t properly managed, the potential risks can be life-threatening. But as these aren’t always as obvious as the “scary” list of all known potential side effects on a medication brochure, people can forget what exactly is at stake if they decide to ignore their doctor’s advice.
And, ultimately, what is at stake is people’s lives.
Research has shown that those who discontinue taking statins are at increased risk of cardiovascular events such as heart attack.
So not only is taking health advice from anyone other than your cardiologist or GP dangerous, it could cost you your life.
Can lifestyle changes alone lower cholesterol?
Having a healthy lifestyle is critical for all of us. Proper attention to diet, exercise, and maintaining a healthy body weight, as well as not smoking or vaping, and getting the right amount of sleep, are the cornerstones of living a long and healthy life and also for avoiding heart attack and stroke. I emphasise this in every patient I see – regardless of whether or not they might benefit from a statin.
But along those lines, one of the arguments that statin sceptics make is that there are other ways to lower your cholesterol levels – namely by changing your diet and increasing your amount of exercise.
While it’s true some people can bring cholesterol levels into a healthy range with lifestyle changes, many will still need to take statins.
Here’s why:
- For some, their cholesterol levels will be too high to manage through diet alone, or they may have other health conditions that put them at greater risk.
- For many, it’s because years of bad habits are hard to change, and the necessary positive lifestyle changes are ever harder to sustain over time. The rising rates of obesity, inactivity, and poor diet in our society are stark evidence of this.
- Focusing solely on diet also ignores the fact that for some people, high cholesterol may occur due to genetics or other conditions – even in those with an otherwise healthy lifestyle.
Now this is not to say that we shouldn’t always be aiming for better. There are substantial benefits in smaller changes, such as adding an extra serve of vegetables to our dinner, swapping one red meat meal a week for oily fish, or walking the kids to school.
But if we ignore a medication proven to lower risk of heart attack and death for this ideal of a world where everyone eats a perfect diet, we will be waiting a very long time.
And while we wait, how many people might suffer from preventable heart attack or stroke, or even die, partly due to the misinformation and fearmongering about statins by a select few with questionable agendas?
Like many of my cardiology and physician colleagues, I’ve been taking a statin for years. And I have absolutely no intention of stopping.
Professor Jason Kovacic is the chief executive and director of the Victor Chang Cardiac Research Institute.
This column is published for information purposes only. It is not intended to be used as medical advice and should not be relied on as a substitute for independent professional advice about your personal health or a medical condition from your doctor or other qualified health professional.
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