Direct-To-Consumer Television Advertising Exposure, Diagnosis with High Cholesterol, and Statin Use

ABSTRACT

BACKGROUND

While statin drugs are recommended for secondary prevention of coronary heart disease (CHD), there is no medical consensus on whether or not a statin should be added to lifestyle change efforts for primary prevention of CHD. Previous research suggests that exposure to direct-to-consumer advertising (DTCA) increases drug demand among those at comparatively low risk. Research has yet to examine whether individual-level DTCA exposure may influence statin use among men and women at high, moderate, or low risk for future cardiac events.

OBJECTIVE

To determine the relationship between estimated exposure to DTCA for statin drugs and two clinical variables: diagnosis with high cholesterol and statin use.

DESIGN

We used logistic regression to analyze repeated cross-sectional surveys of the United States population, merged with data on the frequency of DTCA appearances on national, cable, and local television, between 2001 and 2007.

PARTICIPANTS

American adults (n = 106,685) aged 18 and older.

MAIN MEASURES

Levels of exposure to statin DTCA, based on ad appearances and TV viewing patterns; self-reports of whether or not a respondent has been diagnosed with high cholesterol, and whether or not a respondent took a statin in the past year.

KEY RESULTS

Adjusting for potential confounders, we estimate that exposure to statin ads increased the odds of being diagnosed with high cholesterol by 16 to 20 %, and increased statin use by 16 to 22 %, among both men and women (p < 0.05). These associations were driven almost exclusively by men and women at low risk for future cardiac events. There was also evidence of a negative association between DTCA exposure and statin use among high-risk women (p < 0.05)

CONCLUSIONS

This study provides new evidence that DTCA may promote over-diagnosis of high cholesterol and over-treatment for populations where risks of statin use may outweigh potential benefits.

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Acknowledgements

The collection of the televised pharmaceutical advertising database used in this study was supported from NIH Grant No. 1 R01 CA113407-01A1 and a grant from the Substance Abuse Policy Research Program of the Robert Wood Johnson Foundation. The project was expanded to include ads for other prescription drug products, with support from an unrestricted educational grant to Cornell University from the Merck Company Foundation, the philanthropic arm of Merck & Co. The funders played no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.

Potential Conflict of Interest Disclosure

The project was supported by an unrestricted educational grant to Cornell University from the Merck Company Foundation, the philanthropic arm of Merck & Co.

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Correspondence to Jeff Niederdeppe PhD.

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Niederdeppe, J., Byrne, S., Avery, R.J. et al. Direct-To-Consumer Television Advertising Exposure, Diagnosis with High Cholesterol, and Statin Use. J GEN INTERN MED 28, 886–893 (2013). https://doi.org/10.1007/s11606-013-2379-3

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KEY WORDS

  • DTCA
  • direct-to-consumer advertising
  • statins
  • cholesterol
  • screening
  • treatment