"Don't give up your statins: Experts say warnings that made patients stop taking vital drug have put lives at risk," the Daily Mail reports.
This was the same newspaper that told us two weeks ago that "statins may be a waste of time", so you might be forgiven for being a little confused.
In October 2013, negative media coverage surrounded two articles run by the BMJ, which suggested that the risks of statins may outweigh the benefits of the drugs in preventing heart attacks and strokes.
The articles also said the link between cholesterol and cardiovascular diseases was unproven.
At the time, they were widely reported at face value, with little discussion of their limitations.
A new study aimed to estimate the effect of this intense media coverage in 2013 on the use of statins in the UK.
It found people who were already taking statins were more likely to stop taking them after exposure to a six-month period where media coverage around this topic was particularly intense.
The media coverage was not associated with any effect on people who had been newly prescribed statins.
The researchers estimated that 218,971 people stopped taking statins in the six months after the media coverage, which could potentially be associated with between 2,000 and 6,000 excess cardiovascular events.
This latest study is unable to confirm cause and effect, but it does highlight the impact that health reporting can have.
While uncertainties in science should always be reported, far too often the media will report a dissenting opinion as if it were proven fact.
Perhaps the most notorious example of this was the poor reporting on the now thoroughly discredited alleged link between the MMR vaccine and autism.
Where did the story come from?
The study was carried out by researchers from the London School of Hygiene and Tropical Medicine, the University of Manchester, and the Institute of Pharmaceutical Sciences. It was funded by the British Heart Foundation.
Generally, the media coverage of this study was accurate, but much of the tone of the reporting was arguably hypocritical.
Many media sources appeared to be placing the blame solely on the authors of the 2013 articles, without acknowledging their own role in promoting fear and uncertainty about the use of statins.
For example, at the time the Daily Express' headline was, "Doctors change their minds after 40 years", even though the articles represented a minority opinion.
What kind of research was this?
This was an ecological interrupted time-series study that aimed to estimate the effect on the use of statins in the UK after a six-month period of intense media coverage about the risks and benefits of the drugs.
Ecological studies are good for studying populations or communities, rather than individuals.
In this case, the study is useful for establishing national patterns of statin use, but cannot imply cause and effect between usage and the intense media coverage. There may be other factors influencing changes in statin use.
What did the research involve?
The researchers used prospectively collected data from the UK Clinical Practice Research Datalink (CPRD), which is a database of primary care data from GP surgeries.
The data covers about 6.9% of the UK population, and is broadly representative in terms of age and sex.
The analysis was an interrupted time-series design, where the exposure period to high media coverage was defined as October 2013 to March 2014.
The researchers compared patterns of statin initiation and cessation before and after this time period.
They then calculated the proportions of patients initiating and stopping statin treatment for every month from January 2011 to March 2015.
Potential confounders such as smoking and obesity were controlled for. The analysis only included patients over the age of 40.
Statin initiation was defined as having no previous record of statin prescriptions, and statin cessation as having ended statin prescriptions within that calendar month.
On the assumption of a link between the media coverage and changes in statin use, the researchers estimated the potential public health impact by comparing the number of cardiovascular events among these patients.
What were the basic results?
The study's main finding was that patients already taking statins were more likely to stop after exposure to the high media coverage compared with before.
The stoppage rates were similar both for those who were taking statins because of cardiovascular risk factors, but who had not yet had a stroke or heart attack (primary prevention: odds ratio [OR] 1.11, 95% confidence interval [CI] 1.05 to 1.18), and for those who had already experienced a cardiovascular event (secondary prevention: OR 1.12, 95% CI 1.04 to 1.21).
There was no evidence of changes in statin initiation, either for those prescribed statins for primary prevention (OR 0.99, 95% CI: 0.87 to 1.13) or secondary prevention (OR 1.04, 95% CI 0.92 to 1.18).
The researchers estimated there was an excess of 218,971 patients who stopped taking statins in the six months after the media coverage.
They also estimated that in the following 10 years there could be between 2,000 and 6,000 excess cardiovascular events that wouldn't have otherwise occurred.
How did the researchers interpret the results?
The researchers concluded that, "Controversy over the risks and benefits of statins reported in both the medical and popular press was followed by a transient increase in patients stopping treatment prescribed for primary and secondary prevention.
"Additionally, a marked reduction in the proportion of patients receiving a risk score for cardiovascular disease suggests other important impacts on GP and/or patient behaviour."
This study aimed to estimate the effect on the use of statins in the UK after a six-month period of intense media coverage about the risks and benefits of the drugs.
It found that patients were more likely to stop taking statins after exposure to the high media coverage compared with before the six-month period. However, there was no effect for people who had been newly prescribed statins.
As the researchers acknowledge, interrupted time series studies like this one cannot confirm a causal link between the media coverage and the observed likelihood of stopping statin treatment.
We cannot know the exact reasons why these people may have stopped taking statins. It is possible that other external factors played a role in the observed changes.
Additionally, these changes may have been different in people under the age of 40 or those who purchase low-dose statins over the counter.
One of the researchers, Dr Liam Smeeth, told the media: "Our findings suggest widespread coverage of health stories in the mainstream media can have an important real-world impact on the behaviour of patients and doctors. This may have significant consequences for people's health."
More research is needed to further draw out conclusions, but overall this study highlights the potential impact widely reported health stories can have on people's health behaviour in the real world.
Journalists have a responsibility to ensure their reporting is as balanced and accurate as possible, especially when they are reporting on potential life and death matters, such as heart attack and stroke prevention.
"Don't give up your statins: Experts say warnings that made patients stop taking vital drug have put lives at risk," the Daily Mail reports. This was the same newspaper that told us two weeks ago that "statins may be a waste of time".
Links to Headlines
Fears of 2,000 heart attacks and strokes linked to statins controversy. The Daily Telegraph, June 29 2016
Statins controversy led 200,000 people to stop taking pills, says study. The Guardian, June 28 2016
At-risk heart patients stopped taking statins because of press controversy, study found. Daily Mirror, June 29 2016
'Scaremongering' over statins may have caused 2,000 deaths. The Times, June 29 2016 (subscription required)
Links to Science
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. Published online June 28 2016
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