Purpose of Review
Statins have proven efficacy with a favorable safety profile yet, despite being widely affordable, remain profoundly underutilized. Statins have acquired a bad reputation, which is likely contributing to high rates of nonadherence and discontinuation. The degree to which negative media perceptions contribute to underutilization is unclear.
The media has a key role in informing discussion on the public agenda but also on how issues are framed. In this context, the majority of studies evaluating news coverage suggest that the content on statins is predominantly negative and focused on potential harm. Studies utilizing quasi-experimental and interrupted time series design have shown periods of negative news stories on statins in multiple countries are associated with (a) less statin commencement in eligible patients, (b) high rates of discontinuation, and (c) poor long-term adherence.
This review highlights the deleterious impact of negative media coverage on statin utilization through misattribution of muscle complaints and the nocebo effect. Academia must work with the media to harmonize the public health messaging; however, individual physicians have a critical role in mitigating a harmful narrative of misinformation and actively discredit malinformation.
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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994;344:1383–9.
Downs JR, Clearfield M, Weis S, Whitney E, Shapiro DR, Beere PA, et al. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. Air Force/Texas coronary atherosclerosis prevention study. JAMA. 1998;279:1615–22.
Heart Protection Study Collaborative G. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002;360:7–22.
Shepherd J, Cobbe SM, Ford I, Isles CG, Lorimer AR, Macfarlane PW, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group. N Engl J Med. 1995;333:1301–7.
Collins R, Reith C, Emberson J, Armitage J, Baigent C, Blackwell L, et al. Interpretation of the evidence for the efficacy and safety of statin therapy. Lancet. 2016;388:2532–61.
Pencina MJ, Navar-Boggan AM, D'Agostino RB Sr, Williams K, Neely B, Sniderman AD, et al. Application of new cholesterol guidelines to a population-based sample. N Engl J Med. 2014;370:1422–31.
McClellan M, Brown N, Califf RM, Warner JJ. Call to action: urgent challenges in cardiovascular disease: a presidential advisory from the American Heart Association. Circulation. 2019;139:e44–54.
Steinberg D, Gotto AM Jr. Preventing coronary artery disease by lowering cholesterol levels: fifty years from bench to bedside. JAMA. 1999;282:2043–50.
Tobert JA. Lovastatin and beyond: the history of the HMG-CoA reductase inhibitors. Nat Rev Drug Discov. 2003;2:517–26.
Dickson C. 'Wonder Drug' Statins May Be Dangerous. The Atlantic. 2011. https://www.theatlantic.com/technology/archive/2011/01/wonder-drug-statins-may-be-dangerous/342557/.
Hodgekiss A, Spencer B. How Big Pharma greed is killing tens of thousands around the world. DailyMail; 2016. https://www.dailymail.co.uk/health/article-3460321/How-Big-Pharma-greed-killing-tens-thousands-world-Patients-medicated-given-profitable-drugs-little-proven-benefits-leading-doctors-warn.html.
Brody JE. Weighing the Pros and Cons of Statins. The New York Times; 2018. https://www.nytimes.com/2018/04/16/well/weighing-the-pros-and-cons-of-statins.html.
Brody JE. When the Benefits of Statins Outweigh the Risks. The New York Times; 2019. https://www.nytimes.com/2019/03/18/well/live/when-the-benefits-of-statins-outweigh-the-risks.html.
Bakalar N. Half of People Miss Benefits of Statins. The New York Times; 2019. https://www.nytimes.com/2019/05/03/automobiles/half-of-people-miss-benefits-of-statins.html.
Adams S. Millions taking statins 'needlessly'. The Telegraph; 2011. https://www.telegraph.co.uk/news/health/news/8267570/Millions-taking-statins-needlessly.html.
Gajraj H. Why I've ditched statins for good. The Telegraph; 2014. https://www.telegraph.co.uk/news/health/10717431/Why-Ive-ditched-statins-for-good.html.
Graedon J, Graedon T. People’s Pharmacy: Cognitive side effects of statins remain controversial. Athens-Banner-Herald; 2019. https://www.onlineathens.com/news/20191202/peoples-pharmacy-cognitive-side-effects-of-statins-remain-controversial.
Boutron I, Ravaud P. Misrepresentation and distortion of research in biomedical literature. Proc Natl Acad Sci U S A. 2018;115:2613–9.
Cooper CP, Roter DL. "If it bleeds it leads"? Attributes of TV health news stories that drive viewer attention. Public Health Rep. 2000;115:331–8.
Scheufele DA. Framing as a Theory of Media Effects. Commun. 1999. Winter.
Cheng AT, Hawton K, Lee CT, Chen TH. The influence of media reporting of the suicide of a celebrity on suicide rates: a population-based study. Int J Epidemiol. 2007;36:1229–34.
Ueda M, Mori K, Matsubayashi T. The effects of media reports of suicides by well-known figures between 1989 and 2010 in Japan. Int J Epidemiol. 2014;43:623–9.
Yip PS, Fu KW, Yang KC, et al. The effects of a celebrity suicide on suicide rates in Hong Kong. J Affect Disord. 2006;93:245–52.
Grilli R, Ramsay C, Minozzi S. Mass media interventions: effects on health services utilisation. Cochrane Database Syst Rev. 2002:CD000389.
Martin RM, May M, Gunnell D. Did intense adverse media publicity impact on prescribing of paroxetine and the notification of suspected adverse drug reactions? Analysis of routine databases, 2001-2004. Br J Clin Pharmacol. 2006;61:224–8.
Faasse K, Gamble G, Cundy T, Petrie KJ. Impact of television coverage on the number and type of symptoms reported during a health scare: a retrospective pre-post observational study. BMJ Open. 2012;2:e001607.
Abramson JD, Rosenberg HG, Jewell N, Wright JM. Should people at low risk of cardiovascular disease take a statin? BMJ. 2013;347:f6123.
•• Matthews A, Herrett E, Gasparrini A, et al. Impact of statin related media coverage on use of statins: interrupted time series analysis with UK primary care data. BMJ. 2016;353:i3283 One of the larger studies which showed a period of negative media coverage in the UK resulted in higher rates of discontinuation in both primary and secondary prevention patients.
•• Nielsen SF, Nordestgaard BG. Negative statin-related news stories decrease statin persistence and increase myocardial infarction and cardiovascular mortality: a nationwide prospective cohort study. Eur Heart J. 2016;37:908–16 Largest study performed linking positive or negative statin news coverage to be associated with continuation or discontinuation of statin therapy in Denmark.
Schaffer AL, Buckley NA, Dobbins TA, Banks E, Pearson SA. The crux of the matter: did the ABC's Catalyst program change statin use in Australia? Med J Aust. 2015;202:591–5.
Kriegbaum M, Liisberg KB, Wallach-Kildemoes H. Pattern of statin use changes following media coverage of its side effects. Patient Prefer Adherence. 2017;11:1151–7.
Saib A, Sabbah L, Perdrix L, Blanchard D, Danchin N, Puymirat E. Evaluation of the impact of the recent controversy over statins in France: the EVANS study. Arch Cardiovasc Dis. 2013;106:511–6.
Chisnell J, Marshall T, Hyde C, Zhelev Z, Fleming LE. A content analysis of the representation of statins in the British newsprint media. BMJ Open. 2017;7:e012613.
Kon RH, Russo MW, Ory B, Mendys P, Simpson RJ Jr. Misperception among physicians and patients regarding the risks and benefits of statin treatment: the potential role of direct-to-consumer advertising. J Clin Lipidol. 2008;2:51–7.
• Khan S, Holbrook A, Shah BR. Does Googling lead to statin intolerance? Int J Cardiol. 2018;262:25–7 Provocative analysis showing a correlation between the number of websites available on a google search for statin risks correlated with the national prevalence of statin intolerance.
Newman CB, Preiss D, Tobert JA, et al. Statin safety and associated adverse events: a scientific statement from the American Heart Association. Arterioscler Thromb Vasc Biol. 2019;39:e38–81.
Bradley CK, Wang TY, Li S, et al. Patient-reported reasons for declining or discontinuing statin therapy: insights from the PALM registry. J Am Heart Assoc. 2019;8:e011765.
Stroes ES, Thompson PD, Corsini A, Vladutiu GD, Raal FJ, Ray KK, et al. Statin-associated muscle symptoms: impact on statin therapy-European atherosclerosis society consensus panel statement on assessment, aetiology and management. Eur Heart J. 2015;36:1012–22.
Ganga HV, Slim HB, Thompson PD. A systematic review of statin-induced muscle problems in clinical trials. Am Heart J. 2014;168:6–15.
Kashani A, Phillips CO, Foody JM, et al. Risks associated with statin therapy: a systematic overview of randomized clinical trials. Circulation. 2006;114:2788–97.
Bingel U, Wanigasekera V, Wiech K, et al. The effect of treatment expectation on drug efficacy: imaging the analgesic benefit of the opioid remifentanil. Sci Transl Med. 2011;3:70ra14.
Silvestri A, Galetta P, Cerquetani E, et al. Report of erectile dysfunction after therapy with beta-blockers is related to patient knowledge of side effects and is reversed by placebo. Eur Heart J. 2003;24:1928–32.
Navar AM. Fear-based medical misinformation and disease prevention: from vaccines to statins. JAMA Cardiol. 2019;4:723–4.
Nissen SE, Stroes E, Dent-Acosta RE, Rosenson RS, Lehman SJ, Sattar N, et al. Efficacy and tolerability of evolocumab vs ezetimibe in patients with muscle-related statin intolerance: the GAUSS-3 randomized clinical trial. JAMA. 2016;315:1580–90.
Gupta A, Thompson D, Whitehouse A, et al. Adverse events associated with unblinded, but not with blinded, statin therapy in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm (ASCOT-LLA): a randomised double-blind placebo-controlled trial and its non-randomised non-blind extension phase. Lancet. 2017;389:2473–81.
Bell RA, Hu X, Orrange SE, Kravitz RL. Lingering questions and doubts: online information-seeking of support forum members following their medical visits. Patient Educ Couns. 2011;85:525–8.
Waring ME, McManus DD, Amante DJ, Darling CE, Kiefe CI. Online health information seeking by adults hospitalized for acute coronary syndromes: who looks for information, and who discusses it with healthcare providers? Patient Educ Couns. 2018;101:1973–81.
Bowes P, Stevenson F, Ahluwalia S, Murray E. I need her to be a doctor': patients' experiences of presenting health information from the internet in GP consultations. Br J Gen Pract. 2012;62:e732–8.
Rupert DJ, Moultrie RR, Read JG, Amoozegar JB, Bornkessel AS, O’Donoghue AC, et al. Perceived healthcare provider reactions to patient and caregiver use of online health communities. Patient Educ Couns. 2014;96:320–6.
Nissen SE. Statin denial: an internet-driven cult with deadly consequences. Ann Intern Med. 2017;167:281–2.
Bingel U, Placebo CT. Avoiding nocebo effects to optimize treatment outcome. JAMA. 2014;312:693–4.
Maningat P, Gordon BR, Breslow JL. How do we improve patient compliance and adherence to long-term statin therapy? Curr Atheroscler Rep. 2013;15:291.
Kravitz RL, Bell RA. Media, messages, and medication: strategies to reconcile what patients hear, what they want, and what they need from medications. BMC Med Inform Decis Mak. 2013;13(Suppl 3):S5.
Conflict of Interest
A.J.N. has no relationships to disclose.
R.P. has received consulting fees from Cerenis, Sanofi, and Amgen.
S.E.N.’s institution has received funding to perform clinical trials from Abbvie, AstraZeneca, Amgen, Cerenis, Eli Lilly, Esperion, Pfizer, The Medicines Company, Takeda, and Orexigen; he is involved in these clinical trials, but receives no personal remuneration for his participation, and consults for many pharmaceutical companies, but requires them to donate all honoraria or consulting fees directly to charity so that he receives neither income nor a tax deduction.
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This article is part of the Topical Collection on Statin Drugs
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Nelson, A.J., Puri, R. & Nissen, S.E. Statins in a Distorted Mirror of Media. Curr Atheroscler Rep 22, 37 (2020). https://doi.org/10.1007/s11883-020-00853-9
- Statin intolerance