Pearls From Steven Nissen, MD: On Statin Denial and Cult Diets

Fight statin denial and cult diets 'with good facts and good science'

Statins face the same problem as climate change when it comes to public opinion, and should be defended the same way: "We have to fight back with good facts and good science." That's the argument of Steven Nissen, MD, chair of cardiovascular medicine at the Cleveland Clinic, in this exclusive MedPage Today video.

The following is a transcript of his remarks:

Statins have been around for a long time. They are extraordinarily effective, but [an] internet cult has developed that widely promotes the adverse effects of statins. In many ways, this whole statin denial phenomenon is a little bit like climate denial -- you can't give facts to people who feel so passionately. There are groups of people that will argue that cholesterol has nothing to do with heart disease; that statins are bad for you, [but] they don't really cite any data. The internet is just full of these articles suggesting that there are really serious adverse effects for statins and that people shouldn't take the drugs. And unfortunately, it's now really harming the public.

Statins are the cornerstone of cholesterol-lowering therapies. In fact, they're the only class of drugs that has the FDA-approved indication for morbidity and mortality reduction. Now, we've had recent data that suggest the PCSK9 inhibitors will also get such a label, but that is yet to come. But the important message here is that we probably have more studies of statins than any other therapy in history and we know that they're fundamentally safe, that they're very well-tolerated, but we face this pushback.

The people who are pushing back, the sort of dietary supplement industry, they are not held to any scrutiny because of a law passed in 1994 called DSHEA that allows many claims to be made for dietary supplements that are not based in good scientific studies, they are not regulated by the Food and Drug Administration. So, you see out there all this advocacy for a whole variety of dietary supplements to modify cholesterol or to improve, you know, outcomes related to cholesterol, and almost none of it has any scientific basis at all. You combine that with the kind of natural inclination of patients to take "natural products" and you end up with a problem of people who really need the cholesterol lowering provided by statins not actually getting the drugs.

My advice to fellow physicians is to give patients the facts ... some of the rigorous trials showing benefits of statins. I think we need to push back much more aggressively against the dietary supplement industry, which is promoting snake oil as an alternative to the statins, and to really dig in and educate people. I think we have to talk to the media, the mass media, about this to try to counter this cult.

I think the other thing we have to fight back against are all the wacky diets that are now being promoted that are going to erase heart disease. They're going to reverse heart disease with any one of a variety of cult diets. If you say to patients, "You don't have to take a medication, just follow my diet and your heart disease will go away," people get seduced by that. We have to tell our patients that there isn't any scientific basis. There is no diet that's been shown to reverse heart disease. There is no dietary supplement that's been shown to reverse heart disease, and yet most people in the public are taking these supplements. They believe that they work. We have to fight back with good facts and good science.

To view the video of Dr Nissen, click here. For a contrasting perspective click here for a response from Dean Ornish, MD, and Kim Williams, MD.

This article was first published on MedPage Today and reprinted with permission from UBM Medica. Free registration is required.