The bitter statin debate

Is it a witch hunt and a purposeful attack meant to discredit statin opponents?
Or, is it a genuine plea to try and help people live longer and better?
I wish I knew the real answer, but there is no question that the recent article in the The Mail on Sunday drove a stake through the middle of the statin and cholesterol debate.
The article, written by The Mail on Sunday’s health editor Barney Calman, presented a clear opinion with his title alone: “The deadly propaganda of the statin deniers.” He claims that three prominent cholesterol and statin “deniers,” Zoe Harcombe Ph.D., Malcolm Kendrick MD, and Aseem Malhotra MD, are spreading false information, confusing the public and putting thousands of lives at risk.
Those are bold and serious accusations. The use of inflammatory and accusatory language certainly gives this piece the air of a witch hunt, but the author does include interviews with experts and quotes from the medical literature. Does his argument hold up to scrutiny?
While part of his message does make sense, some of it is off-base. Let’s break down the argument.
Do statins reduce the risk of heart attacks and strokes?
Right off the bat, The Mail on Sunday’s article cites the often quoted statistic of a 50% reduction in heart attacks and a 30% reduction in strokes with statins. Drs. Harcombe, Kendrick, and Malhotra have rightly pointed out many times that these are relative risks, and don’t tell an accurate portrayal of true benefit.
What are the absolute benefits? Is the 50% reduction a decrease from a 1% risk to a 0.5% risk? It turns out we don’t know. The Cholesterol Treatment Trialists’ (CTT) Collaboration, the main publisher of comprehensive statin efficacy data, refuses to release the raw data for third-party verification. It claims a nondisclosure agreement with the pharmaceutical companies who funded the research. Drs. Harcombe, Kendrick, and Malhotra are certainly right in questioning the accuracy and reliability of this data, especially since we can’t know the absolute risk reduction for their claims.
Looking at individual primary prevention trials, the absolute risk reduction varies between 0.2% and 1% risk reduction. That takes on a different urgency than the quoted 50% relative risk reduction.
Are statin opponents on par with the anti-vaccine crowd?
To his credit, Mr. Calman acknowledges the faulty demonization of first dietary cholesterol and then dietary saturated fat. He points out the weakness or complete lack of evidence to support those claims once believed as true (which we should point out would likely still be propagated as true if it weren’t for individuals brave enough to stand up and question the status quo).
He then continues, however, by quoting statin researcher Sir Rory Collins as he compares the opposition to statins to the “disgraced pediatrician…. (who) fabricated evidence to support his idea that… [routine vaccines] triggered autism in infants.” First of all, Drs. Harcombe, Kendrick and Malhotra are not fabricating evidence. They are interpreting the studies done by others. They are bringing to light contradictory studies that are frequently ignored, they are presenting the data with a different perspective, and they are calling out the holes in the data. It is incendiary and incorrect to compare them to anyone who purposely fabricates evidence. That is clearly taking the attack too far, in my opinion.
Is cholesterol completely harmless?
Observational trials such as the Framingham Heart Study and Multiple Risk Factor Intervention Trial (MRFIT) show a clear association that as total cholesterol and LDL increase so does the risk for heart attacks and death. While the strength of the association may be in question, the statistics point to a clear association. Again, not cause and effect, but rather an observed association.
On the other hand, Dr. Zoe Harcombe points out the data she evaluated from the World Health Organization (WHO) from 192 countries showed better survival with increasing cholesterol. Other observational studies in subjects older than 65 years old show a better survival with higher levels of cholesterol. That is enough for some to question cholesterol’s role in death and disease. It does suggest a potential bimodal situation where high cholesterol is associated with both a small increased risk in the young and protection in the elderly. Of course, observational data will not definitively answer the question. It merely suggests an association.
Do statins save lives?
Dr. Kendrick cited an observational paper showing that statins increase life expectancy by a mere 3.5 days. Mr. Calman takes issue with this citing that numerous randomized studies (a higher quality of evidence) have shown reduced risk of death with statin prescriptions. While that statement is true, it is also incomplete. There have also been numerous statin trials that have not shown reductions in all-cause mortality. The data is truly split.
An important consideration is to whom are we specifically referring? Studies have not shown any mortality benefit for lower risk primary prevention in women, and many haven’t shown any mortality benefit in men either. For secondary prevention (when statins are used to treat people with established cardiovascular disease) the mortality data is better, but even then it is estimated 83 individuals need to take the drug for five years to prevent one death.
Mr. Calman then breaks from scientific integrity again to state:
For anyone in any doubt, UK heart disease and stroke deaths plummeted by two-thirds between 1980 and 2013, partly due to fewer smokers and better emergency care, but also because of wider statin use.
I would like to understand how he was able to know the impact of statins above and beyond the development of better medical techniques and, more importantly, the decline in smoking.
Are the risks of statin side effects over-hyped?
Mr. Calman points out that Dr. Malhotra has made claims that 75% of statin users quit within the first year. I echo Calman’s concern as I am not aware of a quality study showing that the rate is this high. On the other hand, others quote a 1% or less side effect incidence in major statin trials. What they fail to mention is that many of those trials have a “run in” period where everyone is given a statin and those who have side effects are excluded from participating in the trial.
Truly measuring statin side effects requires “real world” studies, not pharma-sponsored trials designed to minimize the reporting of side effects.
Are prominent statin proponents heavily paid by pharmaceutical companies?
There is no denying the vast majority of the statin trials are run by doctors with long lists of conflicts of interest. That may not completely invalidate the data, but it does raise the question if we are seeing the whole picture. This is an important concept that Drs. Harcombe, Kendrick and Malhotra are vocal about. The article quotes Mr. Collins saying that he does not accept funding from pharma, but that does not change the fact that much of the data was acquired in large pharma-sponsored trials.
More witch hunt than fact promotion
While the debate may not be clear one way or the other, the important point is that there is a debate. Attempts to discredit and slander opponents of a popular view point do nothing to further the scientific discussion of cholesterol and statins. It’s okay to question scientific norms and disagree with consensus. I would even go so far as to say we should all question the consensus from time to time. The key is doing it in a way that is based in science, is not personal, and is aimed at getting closer to the “truth.”
I am not sure the piece in The Mail on Sunday had that intention. Even if you don’t agree with everything Drs. Kendrick, Harcombe and Malhotra say, they should be applauded for their efforts to further the discussion and challenge the status quo.
Thanks for reading,
Bret Scher, MD FACC


Cholesterol and low-carb diets
Guide Read this guide to learn what cholesterol is, how your body uses it, why low-carb and keto diets may lead to a change in blood cholesterol levels, and whether you should be concerned if your cholesterol increases with a keto or low-carb lifestyle.
Earlier
High LDL cholesterol may protect against dementia – don’t tell the statin pushers!
Management of blood cholesterol just got personal
Cholesterol deniers or statin pushers — is there a middle ground?
Cholesterol
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- Lisa A HBe sure to google Dr. Duane Graveline, who tried so hard to tell his story and alert the FDA to the number of cases of transient global amnesia he personally documented. He was ignored.
- GrantI was started on Lipitor in 2009 and took it with out any side effects until I was prescribed Flecainide in 2016
then the muscle pains started and my Dr. noticed that my Liver Function test was creeping up as well.
She stopped my statin in 2018 and ever since then my liver function tests have gone back to normal or the same as
pre 2008 , my blood glucose has dropped from 8.4 to 5.5 .
Was there ever any emphasis put on the other side effects of statin use when it was released?
Also the muscle waste is another unwanted effect - if I had know about all the complications
associated with what was a very marginal benefit against major complications I would have refused
them a lot earlier. - Elaine WornerPut on Lipitor 80mg for a TIA very tired and kept having head issues I thought was a stroke but was side effects of statin, stopped and felt better later for on Crestor 40gm for a mild stroke and it nearly killed me.continual muscle soreness and quivering, unable to sleep onmy left side and had severe left hip pain. The worse was the cramps OMG the pain would wake up screaming....stpped talking this poison after 5 mibths and it has been nearly 11 months and still have the muscle weakness in legs and the cramps. Would never take this poison again..
Another concern is the fanaticism of the medical proffession in their desire to prescribe these drugs, their unwillingness to believe that these side effects exist and the bullying/intimidation by certain Drs for people to continue them without acknowledging the side effects experienced. A complete failure of Duty of Care, Informed Consent and Do No Harm.
- JunkgirlI am very healthy 70 year old woman on keto a year. I have been Paleo since 2011. 2 yrs ago I had a check up and although my HDLand triglycerides were fine the doctor didn’t like my total cholesterol. We barely talked about it and I went home. Later that afternoon my pharmacy called and said my statin RX was ready. Needless to say, I never picked the RX up and I fired that doctor. I frankly don’t trust doctors anymore. My sister has cancer and is only being urged to go with chemo. Her oncologist will not work with an integrative treatment team nor suggest any alternative. I’m trying to find other types of treatment but I can only do so much. I see real, active Death Panels in modern medicine. Doctors, insurance companies and big pharma and big food among the members.
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- Mary TaylorElaine Warner post TIA reduce BP, exercise, intermittent fasting and follow the Holman Protocol. Then re evaluate statins
- Jane E MorrissonI was on Lipitor for 5 years in my 50's (I am currently 66). I had weird issues of suddenly not being able to memorize music well (I am a singer). Also, I felt as if I kept forgetting where I was going while driving. I also experienced sudden bouts of rage about the most unimportant things. I was reading about statin side-effects when I recognized these problems. I quit the statin, and the rage issue disappeared within a couple of weeks, as did the memory loss issues. I will never take a statin again. Also, I keep reading that higher cholesterol is protective in women.
- RonI think the bottom line is 'It's your body'. Whether you go to a dentist or a doctor, it's up to you what you put in it. Don't just trust those with a white lab coat, investigate and if you feel the pharma isn't working on what needs to be taken care of, stop it. If it's not low carb or low fat then find the lifestyle perfect for you. Learn!!
- L MeredithAnyone can do some careful research (read Thomas E. Levy, MD, JD) and learn that the only type of cholesterol that’s a problem for CVD and etc. is Lp(a). Do statins remove or prevent the development of this particular type of cholesterol, Lp(a)? NO!!!! Statins remove the types of cholesterol the body needs for good health, especially for brain health. Watch and see — the link between statins and dementia will become obvious over time. Big Pharma knows this, and they own the medical establishment, and the media. Statins are just another product for them to sell. They are Big Tobacco now, telling everyone how safe their products are while hiding the truth.
- Michael WWakefield wasn’t exonerated- and given the numerous measles outbreaks around the world - shouldn’t anti-vax people be having a good hard look at them self’s
- Stacy KimbellI know someone (not me) with high cholesterol who has been doing keto and her labs came back higher with TC = 473 HDL = 74, LDL = 377. So remnant cholesterol is 22. RC/HDL is .29 which seems good to me but her doctor is freaking out, wants her on something more powerful than a statin as well as a heart monitor. Any suggestions?
- JeanmarieMy mother was on statins for maybe a couple of years, a few years before she died of dementia at 88 last year. She experienced Transient Global Amnesia, and she was also very bitchy, which was NOT at all normal for her. My sister and I tried to persuade her to go off the drugs, and eventually she did (I think the TGA scared her). Several years later she was in a terrible car accident and suffered a traumatic brain injury, from which she largely recovered over time, and died 3 1/2 years later, with dementia starting in about a year before she died. I could kill that doctor that persuaded her to take statins, which she certainly never needed. There was no history of heart disease in her family and she had no risk factors, aside from whatever her cholesterol level was. I think it's likely that statins contributed to her susceptibility to dementia, particularly after she also suffered a TBI. Incidentally, once she was off the statins, she reverted to her normal sweet personality, which she maintained until the end.
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- Tony PI was on statins early on, in late 1990s / early 2000s , in some trials in Australia.
Both sides of my family had a history of heart disease, so I was on light blood pressure medication including asprin as a preventative measure. It was suggested I trial statins by my doctor, which I did. I had regular blood tests and following them, a statin manufacturers representative would call me to check my progress. My cholesterol dropped very substantially, so much indeed that following one phone conversation the representative sought advice, and then they told me to stop taking statins immediately, which I did.
I had however already suffered major side effects, every midday I would have to sleep for an hour+ as I could not stay awake, and I was a rep on the road. The other effect was that I completely lost my sex drive, and that happened almost overnight. I had been someone who was very highly sexually motivated. After that I have never got back the drive that I had before. At the time I was in my early 40s.
I have never taken a statin since. I'm now approaching the age of 70.
I discovered Low Carb / Keto 18 months ago, eat heaps of fats, very low carbs, and now have very low figures for cholesterol and extremely low triglycerides, all other lab results are perfect too. My doctor tells me that under the guidelines that I'm not even eligible for statins. I consider statins to be a dangerous drug, to be avoided at all times.
So the chain goes:
Pharma --> Charity --> Collins.
He's still conflicted as hell just more adept at hiding it!
there is in small print the following note "This means in a large clinical study 3% of patients taking a sugar pill or a placebo had a heart attack compared to 2% taking Lipitor"
that means the absolute risk is 1% not 36% and 1% I suggest is statistically irrelevant so where does 36% come from well it's the Relative Risk Ratio a mathematical process to make the absolute risk look impressive
I don't suppose for one moment statins would have made Billions of $ profit if the original Ad said Lipitor reduces the risk of a heart attack by 1%