Media coverage of statins may have led to 2000 cardiovascular events

Over 200 000 patients may have stopped taking statins because of media reports of side effects, leading to 2000 extra cardiovascular events within 10 years, research in The BMJ warns this week.1

The study used prospectively collected data from the UK Clinical Practice Research Datalink study to calculate how many patients had started or stopped taking statins after the intense media coverage of the drug’s side effects from October 2013 to March 2014.

“Our findings suggest that widespread coverage of health stories in the mainstream media can have an important, real world impact on the behaviour of patients and doctors,” said Liam Smeeth, of the London School of Hygiene and Tropical Medicine and one of the study’s authors, at a press briefing in London to launch the study.

The BMJ has been strongly linked to the statins controversy after publishing an article by John Abramson and colleagues in 2013 that reanalysed data from the Cholesterol Treatment Trialists’ Collaboration.2 Abramson said that side effects from statins, such as muscle pain, were more common than previously thought, occurring in 18-20% of people.

At the time, the National Institute for Health and Care Excellence (NICE) was revising its recommendations for the use of statins to broaden their use in preventing cardiovascular disease. The BMJ’s article triggered an intense debate within the medical profession that was picked up by the media. Media coverage, this latest paper says, peaked in March 2014. Abramson’s figure was revised down to “up to 9%” the following May. And in July NICE reduced its recommendations for prescribing statins from a greater than 20% risk to a greater than 10% risk of a cardiovascular event in 10 years.3

This latest study used observational data to show that, from October 2013 to March 2014, 11% of people taking statins for primary prevention and 12% of those taking them for secondary prevention had stopped treatment. Previous research found that two thirds of people who stop statins will restart them. Older people and those who had taken statins for longer were most likely to stop their treatment.

At the press conference Peter Weissberg, medical director at the British Heart Foundation, which co-funded the study, warned that confidence in the evidence can be shaken by opinions published in the mainstream media. But he argued that medical journals had become increasingly liable to bias over the past decade.

“We now know that several of the leading medical journals have got axes to grind,” he said. “The BMJ, for example, have made no secret that they do not like the ‘medicalisation’ of the normal population.”

But journalists at the press conference such as Laura Donnelly, health editor for the Daily Telegraph, questioned The BMJ’s role in triggering this period of controversy over statins. She said that her paper had barely covered The BMJ’s article but had written about NICE guidance and US guidelines on statins.

Fiona Godlee, editor in chief of The BMJ, said, “I think that it’s both appropriate and necessary to question the growing tendency to medicalise healthy people. The BMJ strives at all times to do this in line with the evidence, while also calling for far greater accountability and openness than is currently the case.

“The article we published by John Abramson and colleagues was not an opinion piece. It was a critical analysis of the available evidence. Its main thrust was to question the extent of the benefit of statins in people at low risk of heart disease. This has not, to my mind, been adequately responded to by those promoting the wider use of statins.”