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Statin Denial: An Internet-Driven Cult With Deadly Consequences

IN RESPONSE: Dr. Bamji's comment reflects the typical perspective offered by statin denial cults. That he acknowledges membership in a notorious organization known as The International Network of Cholesterol Skeptics is not surprising. Inquisitive readers should visit the Web site of this pseudoscientific organization, which promotes a book entitled Fat and Cholesterol Don't Cause Heart Attacks and Statins Are Not the Solution (1). The Web site asks visitors, Have you had any side effects from statin treatment? and offers referral to a medical malpractice law firm. Such fringe organizations choose to ignore the massive body of evidence on the effects of statins on vascular disease, including the meta-analysis of randomized trials involving 170000 patients by the Cholesterol Treatment Trialists' Collaboration (2). Dr. Bamji repeats antistatin zealots' frequent claim that the favorable clinical trial data on statins reflect collusion between drug manufacturers and academic authors funded to conduct clinical trials. Dr. Davis suggests that the number needed to treat (NNT) for statins is not clinically significant and that it would therefore be reasonable for a patient to discontinue statins because many patients would observe no benefits. If we accept this logic, we would cease to administer most preventive therapies, which have similar NNTs to statinsincluding influenza vaccination, which has an NNT of 40 (3). Drs. Bamji and Davis both ignore the scientific facts. In the meta-analysis by the Cholesterol Treatment Trialists' Collaboration, the annual rate for major vascular events in 21 placebo-controlled statin trials was reduced from 3.6% to 2.8% for each decrease in low-density lipoprotein cholesterol of 1 mmol/L (38.7 mg/dL) (relative risk, 0.78 [95% CI, 0.76 to 0.81]; P< 0.001). The observed event reduction translates to a 5-year NNT of approximately 25. The relative risk for coronary heart disease mortality in this meta-analysis was similar at 0.80 (CI, 0.73 to 0.86). Dr. Bamji is of course correct that some patients experience adverse effects when they take statins. I never suggested that all statin-associated muscle symptoms represent the nocebo effect. In fact, I previously reported a randomized clinical trial that confirmed statin-induced muscle symptoms by a crossover design in a substantial fraction (approximately 40%) of patients with a strong history of statin intolerance (4). In my editorial, I sought to warn practitioners about such groups as The International Network of Cholesterol Skeptics that seek to poison public perceptions about statins. Dr. Bamji's comment reinforces this warning and emphasizes the need for health care providers to proactively educate their patients about the dangers of these cults.