| Style over substance|
Statin denialism (also known as cholesterol denialism) is a form of pseudoscientific denialism that asserts that blood LDL cholesterol levels do not increase the risk of cardiovascular disease and/or that statin usage does not reduce the likelihood of cardiovascular disease. Proponents claim that statins should be avoided because they are sold by Big Pharma and cause adverse side effects. It is promoted by LCHF conspiracy theorists and has a presence on social media platforms such as Twitter.
Statin or cholesterol deniers claim that saturated fat has wrongly been demonized by medical scientists and is healthy for dieting in very high quantities. They say that there is no link between blood cholesterol levels and the risk of heart disease and other cardiovascular diseases. This view is contradicted by scientific evidence and has been described as bad science and dangerous.
The leading advocates of statin denialism are associated with the The International Network of Cholesterol Skeptics (THINCS). They have been accused of "cherry-pick[ing] the scientific literature to find studies that support their theses, ignore the flaws in those studies, and ignore the vast body of literature that contradicts them." Statin denialists are known to exaggerate the side effects of statins and utilize scaremongering tactics.
Criticism from the medical community
In 2017, cholesterol denialist Aseem Malhotra and colleagues published an article which disputed the link between blood cholesterol levels and occurrence of heart disease. The authors also suggested that "stopping statins may paradoxically save more lives". The article was criticized by the medical community. Cardiologist Tim Chico commented that "high cholesterol has been proven beyond all doubt to contribute to coronary artery disease and heart attack […] to say the cholesterol hypothesis is dead is simply incorrect."
Cardiologist Steven E. Nissen, has described statin denialism as an "internet-driven cult with deadly consequences." He has also written that "we have abundant scientific evidence demonstrating that treatment of high risk primary prevention patients substantially reduces the risk of cardiovascular morbidity." Whilst acknowledging that statins, like other drugs, have adverse effects, "the benefits are so well documented that every effort should be made to encourage use of these drugs in appropriate patients."
Professor of Medicine and Epidemiology Rory Collins has compared statin denialism to flat earthism, he has noted "the claims that blood LDL cholesterol levels are not causally related to cardiovascular disease (which is really in the same realm as claiming that smoking does not cause cancer) are factually false."
James Stein a Professor of Cardiovascular Research has stated that "many lives have been lost or impaired because of statin non-compliance."
"But they're measuring the wrong things!"
Blood levels of LDL cholesterol (the "bad" cholesterol correlated with heart disease) are typically calculated by measuring total blood cholesterol (in mg/dL in the U.S. and mmol/L elsewhere), subtracting the measured amount of HDL cholesterol, and further subtracting a constant fraction of the measured blood triglycerides.
While this is good enough for most people, cholesterol denialists aren't most people. They'll claim that it's the ratio of LDL cholesterol to HDL cholesterol, not the absolute amounts, that matter, and therefore cholesterol doesn't cause heart disease. They'll claim that the triglyceride-to-cholesterol ratio isn't always constant, which screws up the calculation for LDL cholesterol levels, therefore cholesterol doesn't cause heart disease. They'll claim that it's the LDL particle count (LDL-P), not the LDL cholesterol level (LDL-C) that matters, therefore cholesterol doesn't cause heart disease. They'll claim that there are two kinds of LDL cholesterol molecules -- large and fluffy, versus small and dense -- and that therefore cholesterol doesn't cause heart disease. I think you can see the pattern here.
List of notable statin denialists
- Butter nonsense: the rise of the cholesterol deniers
- Statin Denialism
- The Movie “Cholesterol: The Great Bluff” Is an Exercise in Denialism
- Lansberg et al 2018. Nonadherence to statins: individualized intervention strategies outside the pill box. Vasc Health Risk Manag 14: 91–102.
- Demasi, M; Lustig R. H; Malhotra A. (2017). "The cholesterol and calorie hypotheses are both dead — it is time to focus on the real culprit: insulin resistance". The Pharmaceutical Journal doi:10.1211/CP.2017.20203046.
- Expert reaction to new report on statins and the cholesterol hypothesis
- Nissen SE. (2017). "Statin Denial: An Internet-Driven Cult With Deadly Consequences". Ann Intern Med. 2017 Aug 15;167(4): 281-282.
- Nissen Calls Statin Denialism A Deadly Internet-Driven Cult
- Dr. James Stein Speaks Out Against "Statin Denialism"
- Editors-in-chief of major cardiovascular journals claim medical misinformation puts “lives at stake”.
- Hill JA, et al. Medical misinformation: vet the message!. European Heart Journal - Cardiovascular Pharmacotherapy 5 (2): 62-63.
- Medical Misinformation: Vet the Message!. List of the journals that have published the editorial.
- LDL-Cholesterol – The “Bad” Cholesterol Explained, Sigurdsson, Doc's Opinion, 24-Mar-2019
- The Diet-Heart Myth: Why Everyone Should Know Their LDL Particle Number, Chris Kresser, 17-March-2019
- Tim Noakes called a 'cholesterol denialist'