Negative Statin-Related News Linked With Drug Discontinuation, Increased CV Risk

Whether patients decide to keep taking or quit statin therapy may be influenced by their exposure to positive and negative stories about the lipid-lowering drugs in the media, according to the results of a new study.

More importantly, the research suggests the decision to stop statin therapy comes at a high clinical cost. Compared with individuals who continued treatment, those who stopped their statin had a 26% higher risk of MI and an18% higher risk of cardiovascular death—both statistically significant—from cardiovascular causes.

“Amongst physicians, this is very common knowledge,” senior investigator Børge Nordestgaard, MD, of Copenhagen University Hospital (Denmark), told TCTMD. “So many physicians know that once there has been a story in the news—for example, statins are bad for you, statins cause muscle pain—there are always heaps of patients that come into their office saying they now want to stop taking the statin.” Most doctors likely expect that discontinuations spike in response to bad news stories, he added, “but that’s not the same as showing it.”

Donald Lloyd-Jones, MD, of Northwestern University Feinberg School of Medicine (Chicago, IL), who was not involved in the study, stressed the observational nature of the analysis, and like Nordestgaard, said the study is not designed to infer causal associations from the data.

But while he is cautious in interpreting the results, he has seen firsthand how the media can influence patient behavior.

“I think all of us as practicing physicians have had patients bring media stories into the office—both positive and negative, but in my experience, more often negative—to ask why am I on this medication? Should I stop taking it? Is it dangerous? And not infrequently, [to say] I have already stopped this medication because I read this article,” Lloyd-Jones told TCTMD. “That really concerns me because when we start medications, we try to indicate why we’re doing that. Typically that’s because these medications have a strong evidence base to prolong life and prevent heart attack and stroke.”

The study was published online December 2, 2015, in the European Heart Journal.

Denmark Tracks All Prescriptions

Speaking with TCTMD, Nordestgaard said the study is unique in that all statin prescriptions are tracked and recorded in the Danish Registry of Medicinal Products Statistics, all hospital visits captured in the Danish Patient Registry, and all deaths recorded by the Danish Civil Registration System.

To empirically test the idea that negative news stories could have an adverse impact on patient adherence, Nordestgaard, along with Sune Nielsen, MD, also of Copenhagen University Hospital, studied 674,900 people aged 40 years or older who started on statin therapy between 1995 and 2010. Statin-related news stories published during the same years in newspapers, magazines, Danish websites, and news bureau feeds as well as those appearing on the radio and television were identified by searching a national media database.

In total, the researchers identified nearly 2,000 story transcripts covering statin therapy, and of these more than half were considered neutral, 731 were considered positive, and 110 were classified as negative. For each individual, negative statin-related media exposure was estimated as the weighted sum of the negative news stories published in the first 6 months following the dispensation of the first statin prescription.

Overall, less than 1% of the Danish population was taking a statin in 1995 but this percentage increased to 11% by 2010. During this same period, discontinuation of statin therapy within the first 6 months increased from 6% in 1995 to 18% in 2010. In terms of predicting early statin discontinuation, those exposed to negative statin-related news were 9% more likely to stop taking their statin rather than continue treatment. Men, those taking a higher statin dose, and those with an ethnicity other than Danish were also more likely to stop taking a statin.

In contrast, positive statin-related news in the first 6 months after statin initiation was associated with an 8% reduction in the risk of discontinuing therapy. Similarly, those with cardiovascular disease at the time of statin dispensation were also significantly less likely to stop therapy.  

Regarding the impact of stopping statins, the 10-year incidence of MI and death from cardiovascular causes both were higher in patients who failed to continue taking their therapy.

“In Europe, we have had a lot of negative press about statins, which I think was very unbalanced compared with how little evidence was behind it,” said Nordestgaard. Regardless, he said he believes it is important for the media to report on developments in medicine and remains a staunch advocate of press freedom. “It is the physicians job to balance whatever is negative in the media with the evidence base showing the positive effect of statins,” he added.

Impact Of Media On Patient Perceptions

Nordestgaard noted that when statins first emerged on the market, negative stories were limited or nonexistent because these new drugs effectively lowered cholesterol and were later shown in clinical trials to prevent cardiovascular events. With fewer patients taking the drugs, reports about possible side-effects, such as muscle pain, as well the more recent concerns about diabetes, were scant. The drugs also had a significantly better side-effect profile than other LDL-lowering medications on the market.

“From my point of view, side effects from statins are important but they are really minimal compared with side effects from so many other drugs,” said Nordestgaard. “And they should also be balanced with the positive effects of statins in terms of reducing morbidity and mortality.”

To TCTMD, Lloyd-Jones said it can be disheartening when a patient forgets the office conversation with the physician and instead pays more attention to the news article. In many cases, the media reports about statins are not very nuanced or do not address the patient’s individual situation and their potential benefit or harms from therapy.

As a case in point, Lloyd-Jones pointed to the presentation and publication of the 2013 American Heart Association/American College of Cardiology cholesterol and cardiovascular risk clinical guidelines. As co-chair of the guidelines assessing cardiovascular risk, he thought there was a lot of negative or confusing coverage and that many stories included commentary and opinions from experts who were not completely familiar with the recommendations. This led to a lot of questions from patients, said Lloyd-Jones.

“I had numerous patients come in to tell me they had stopped their statins because of those articles,” he said. “And these were patients who already had cardiovascular disease, who had significant problems and were going to get significant benefit from statins. But the doubt and confusion sowed from stories that I think were ill-founded was remarkable and disheartening. I would hazard a guess that there were many patients who had heart attacks and maybe even died as a result of those articles.”

The bottom-line, he said, is that the media, physicians, and scientists need to be careful to present research with all of its “warts, flaws, and benefits, and not just go for the headline.” And while it can be tough to combat negative news stories, he said that informed consumers of healthcare tend to make better patients.   

Source: 
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. 2015;Epub ahead of print.

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