December 2, 2015

expert reaction to Danish study investigating negative news stories about statins, continuation of statin treatment, heart attacks and early deaths

The effect of statin-related news stories on people continuing with statin prescriptions and health outcomes in a Danish population is the subject of a paper published in the European Heart Journal. The authors report an association between discontinuing statin use early and heart attack and risk of death from cardiovascular disease. A Before the Headlines analysis accompanied these comments.

Prof. Jane Armitage, Professor of Clinical Trials and Epidemiology & Honorary Consultant in Public Health Medicine, Clinical Trial Service Unit & Epidemiological Studies Unit, University of Oxford, said:

“This study from Denmark illustrates the association between negative stories in the media about statins and people stopping their prescribed statins. It is in line with other evidence from Australia that negative statin stories influence behaviour and indirectly lead to heart attacks that might not otherwise have happened. Journalists should take note. Given the extensive body of high-quality evidence from randomised studies showing that statins safely reduce the chances of heart attacks and strokes it is important that doctors use the best available evidence when deciding to offer a statin to their patient. Unfortunately these media stories are probably also influencing doctors’ attitudes to statins and making them less likely to prescribe.”

Prof. Stephen Evans, Professor of Pharmacoepidemiology, London School of Hygiene & Tropical Medicine, said:

“This paper studies Danish people who, a few years ago, were given a first prescription for a statin. They were then classified into two groups depending on whether they were given another prescription in the next six months. Those who died in that period were excluded. The results are presented as whether they continued or discontinued their prescriptions.

“There are a number of strengths to the study, mainly based on the fact that in Denmark it is possible for researchers to obtain the data on prescriptions and health outcomes for everyone in the country.  Data are complete, which is rare. A number of the comparisons made, because they are based on very large numbers, have very little statistical uncertainty, even though the differences are not large. For example, those who do not get another prescription (referred to as “early discontinuation”) are on average two years younger than those who do get another prescription. The findings in relation to patient characteristics are just as one would expect. Being at higher risk for heart attacks makes it more likely patients will continue.

“The weaknesses of the study are that it looks at trends over time that may have many factors contributing to reasons for having another prescription but focuses on just a few. The large size means that very small effects can still be found to be “statistically significant” and vulnerable to over-emphasis. Being certain that it is the media stories that cause discontinuation requires some assumptions, though they are reasonable. There are some very complex methods used so it is not easy to follow exactly what has been done, but they are methods that are generally valid. The authors offer warnings that it is not possible to be sure of the causes of discontinuation in this study.

“This study looks at positive and negative stories in the media and finds some evidence, not very surprising, that the media has a small effect on patients’ decision-making. “Scare” stories sell newspapers; when the stories are scares about a pill that may give a long-term benefit but for which there is no instant gratification in taking them, it is unsurprising that they affect decisions of individuals to stop taking their pills, though the effect is not large.

“Proponents of statin use warn against relying on observational studies of this type when assessing adverse effects of statins themselves, and they are right since randomised trials provide much stronger evidence. We do not have trials of whether the media will provide positive or negative stories so we have to rely on studies like this for our evidence.

“Given the knowledge on the benefits of statins, it is also unsurprising that not continuing on a statin leads to higher rates of heart attack and death. Again the effects are quite small but they affect large numbers of people.

“The message from the paper should be listened to by journalists and the media as well as by patients. The media need to be responsible in their use of scare stories – they may affect patients’ health. Patients need to be aware that the media enjoy such stories but they may affect their own health adversely.”

Prof. Peter Weissberg, Medical Director, British Heart Foundation, said:

“This interesting study raises important questions about how people make decisions that affect their health and the consequences of those decisions. It is important for patients that their doctors base their advice on objective interpretation of the best evidence available rather than biased reports in the lay and medical press.

“Everyone is influenced to a certain degree by the media and this study emphasises why it is important that medical professionals, in particular, should be guided by the scientific evidence rather than opinion. Thanks to donations from the UK public, BHF-funded research has provided very strong and clear evidence that statins reduce the risk of someone dying from or being disabled by a heart attack or stroke.”

Prof. Keith Neal, Emeritus professor of Epidemiology, University of Nottingham, said:

“This is good evidence that statins prevent heart attacks and early death. The only other explanation is people who are likely to die stop statins more than those with lower risk.  Despite having an NHS we are unable to do studies like this in the UK because of no record linkage of the Scandinavian standard. Their data systems allow these results to be very robust.”

‘Negative statin-related news stories decrease statin persistence and increase myocardial infarction and cardiovascular mortality: a nationwide prospective cohort study’ by Sune Fallgaard Nielsen and Børge Grønne Nordestgaard published in the European Heart Journal on Wednesday 2 December 2015. 

Declared interests

Prof. Jane Armitage: “I have coordinated academic led studies of the use of statins in high-risk people which have shown their benefits. These studies have received funding from Pharmaceutical companies including Merck who make simvastatin but have been conducted and reported independently of the funders. I abide by the departmental policy of not accepting personal payments or honoraria from Industry other than the receipt of reasonable expenses and travel costs to attend meetings.”

Prof. Stephen Evans: “I have no conflicts of interest in relation to this area.  I was a member of the panel that advised the British Medical Journal on whether two articles should be retracted that were “negative” about statins. I am a member of the EU committee on risk assessment of medicines at the European medicines Agency.”

Prof. Keith Neal: “No interests apart from have taken statins for over 5 years”.

None others received.