Monday News from EAS Helsinki 2021: Anitschkow Lecture
Professor Sir Rory Collins, University of Oxford, UK
We live in the Information Age, with access to information 24/7. Yet, as Professor Sir Rory Collins reminded us in his Anitschkow lecture, not all information is valid. In other words, misinformation—fake news—is as much an issue in scientific literature as it is in the general media.
Misinformation about statins—both their benefits and side effects—is one example. Some media highlighted statin putative side effects, which undoubtedly contributed to nonadherence and underutilization of this foundational lipid lowering therapy (1). According to Professor Collins, the media is not solely responsible, citing examples of individuals from within the clinical community who have criticised the evidence-base for statins (2). Still, there is overwhelming evidence from the Cholesterol Treatment Trialists Collaboration incorporating data from 27 randomised controlled trials in 175,000 patients followed for more than 5 years that statins significantly reduce cardiovascular events and death (3). Weighing evidence for the benefit versus harm of statin therapy clearly demonstrated that statin treatment given in either primary or secondary prevention settings halves the risk of life-threatening vascular events. In contrast, the risk of potential harm including myopathy, haemorrhagic stroke, and new-onset diabetes was very much lower, equating to about 5, 5-10 and 50-100 cases per 100,000 patients treated with a statin (4). A subsequent analysis of the efficacy and safety of statins in 2016 reiterated the same message (5). These conclusions are strengthened by the quality of evidence, based on randomized controlled blinded studies.
Statin fake news: Why does it matter?
As reiterated by the 2019 ESC/EAS guidelines (6), statins are foundational for lowering low-density lipoprotein cholesterol (LDL-C), the major causal risk factor for atherosclerotic cardiovascular disease (ASCVD). Disinformation about statins does patients and clinicians a disservice, contributing to nonadherence and early treatment discontinuation, clinical inertia in follow-up, and impacting clinical outcome. The Europe-wide DA VINCI study illustrates the missed opportunities in lipid management (7). Across all patient groups, high intensity statin therapy was only used in about one-third of ASCVD patients, despite guideline recommendations for maximally tolerated statin therapy, ideally in combination with other lipid lowering therapy to attain LDL-C goal.
In concluding remarks, Professor Sir Collins emphasised that it is the responsibility of all scientists to rigorously counter medical disinformation that is relevant to public health. Societies such as the EAS have a key role in developing a system that allows rapid assessment and rebuttal of misleading information in the scientific literature. Additionally, researchers should be more aware and better informed about the relative strengths and weaknesses of different types of evidence.
Unless medical disinformation is addressed, it will continue to hamper efforts to improve statin uptake and thus reduce disability and death due to ASCVD.
Find more at the meeting
- This lecture is available on demand: EAS 2021; Anitschkow Lecture: Post-truth Medicine: Death and Disability by Disinformation
- Nelson AJ, Puri R, Nissen SE. Statins in a distorted mirror of media. Curr Atheroscler Rep 2020;22(8):37.
- Sunday Express June 2018. Ditch pills to beat heart disease.
- Cholesterol Treatment Trialists’ (CTT) Collaborators, Mihaylova B, Emberson J, Blackwell L, et al. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet 2012;380:581-90.
- Collins R, Armitage J. High-risk elderly patients PROSPER from cholesterol-lowering therapy. Lancet 2002;360:1618-9.
- Collins R, Reith C, Emberson J, et al. Interpretation of the evidence for the efficacy and safety of statin therapy. Lancet 2016;388:2532-61.
- Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020;41:111-88.
- Ray KK, Molemans B, Schoonen WM, et al. EU-Wide Cross-Sectional Observational Study of Lipid-Modifying Therapy Use in Secondary and Primary Care: the DA VINCI study. Eur J Prev Cardiol 2020 Aug 28;zwaa047.