Impact of statin related media coverage on use of statins: interrupted time series analysis with UK primary care dataBMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i3283 (Published 28 June 2016) Cite this as: BMJ 2016;353:i3283
- Anthony Matthews, research assistant1,
- Emily Herrett, lecturer1,
- Antonio Gasparrini, senior lecturer2,
- Tjeerd Van Staa, professor3 4,
- Ben Goldacre, senior clinical research fellow1,
- Liam Smeeth, professor1,
- Krishnan Bhaskaran, senior lecturer1
- 1Department of Non-Communicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- 2Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
- 3Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, Manchester, UK
- 4Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrect, Netherlands
- Correspondence: K Bhaskaran
- Accepted 22 May 2016
Objective To quantify how a period of intense media coverage of controversy over the risk:benefit balance of statins affected their use.
Design Interrupted time series analysis of prospectively collected electronic data from primary care.
Setting Clinical Practice Research Datalink (CPRD) in the United Kingdom.
Participants Patients newly eligible for or currently taking statins for primary and secondary cardiovascular disease prevention in each month in January 2011-March 2015.
Main outcome measures Adjusted odds ratios for starting/stopping taking statins after the media coverage (October 2013-March 2014).
Results There was no evidence that the period of high media coverage was associated with changes in statin initiation among patients with a high recorded risk score for cardiovascular disease (primary prevention) or a recent cardiovascular event (secondary prevention) (odds ratio 0.99 (95% confidence interval 0.87 to 1.13; P=0.92) and 1.04 (0.92 to 1.18; P=0.54), respectively), though there was a decrease in the overall proportion of patients with a recorded risk score. Patients already taking statins were more likely to stop taking them for both primary and secondary prevention after the high media coverage period (1.11 (1.05 to 1.18; P<0.001) and 1.12 (1.04 to 1.21; P=0.003), respectively). Stratified analyses showed that older patients and those with a longer continuous prescription were more likely to stop taking statins after the media coverage. In post hoc analyses, the increased rates of cessation were no longer observed after six months.
Conclusions A period of intense public discussion over the risks:benefit balance of statins, covered widely in the media, was followed by a transient rise in the proportion of people who stopped taking statins. This research highlights the potential for widely covered health stories in the lay media to impact on healthcare related behaviour.
Contributors: All authors contributed to the design of the study. AM extracted the data, wrote the statistical programmes, and wrote the first draft. All authors contributed to further drafts and approved the final manuscript. AM and EH contributed equally. KB is guarantor.
Funding: This study was funded by the British Heart Foundation. KB holds a Sir Henry Dale Fellowship jointly funded by the Wellcome Trust and the Royal Society (grant No 107731/Z/15/Z). LS is funded by a Wellcome Trust senior fellowship in clinical science. The British Heart Foundation, the Wellcome Trust, and the Royal Society had no role in the design, analysis, or writing up of this study.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: AG received grants from Medical Research Council, during the conduct of the study, and personal fees from University of Umea, unrelated to the submitted work; TVS received personal fees from GSK, Roche, and Sanofi for presenting on methods for pragmatic trials and grant funding from GSK unrelated to the submitted work; BG received grants from the Laura and John Arnold Foundation, Wellcome Trust, and the Health Foundation and receives additional income from speaking, writing, and broadcasting on problems in science and medicine; LS reports grants from Wellcome Trust and British Heart Foundation during the conduct of the study, grants from Wellcome Trust, Medical Research Council, National Institute for Health Research and the European Union outside the submitted work, personal fees from GSK for advisory work unrelated to the submitted work, grant funding from GSK for academic research unrelated to the submitted work, acts as an unpaid steering committee chair for AstraZeneca for a randomised trial unrelated to the submitted work, and is a trustee of the British Heart Foundation; KB received grants from British Heart Foundation, Wellcome Trust, and Royal Society during the conduct of the study, and grant funding from Medical Research Council and National Institute for Health Research unrelated to the submitted work
Ethical approval: The prespecified study protocol was approved by the Independent Scientific Advisory Committee for MHRA Database Research (ISAC), and the approved protocol including amendments is supplied in appendix part 11. Approval was also received from the London School of Hygiene and Tropical Medicine ethics committee.
Data sharing: The data were obtained from the Clinical Practice Research Datalink (CPRD). CPRD is a research service that provides primary care and linked data for public health research. CPRD data governance and our own license to use CPRD data do not allow us to distribute or make available patient data directly to other parties. Researchers can apply for data access at www.cprd.com, and must have their study protocol approved by the Independent Scientific Advisory Committee for MHRA database research (details at www.cprd.com/isac).
Transparency: The lead author affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.
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