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Q&A: Misinformation drives nonadherence to statin therapy
Despite the CV benefits being well-documented, many patients are nonadherent to statin therapy.
Although this is often attributed to adverse events, particularly musculoskeletal pain or weakness, Cardiology Today Editorial Board member Steven E. Nissen, MD, MACC, identified another reason in an editorial published in the Annals of Internal Medicine: an “internet-driven cult” promoting unproven criticisms of statins has diminished their reputation among some patients and driven their decision to discontinue therapy, leading to “deadly consequences.”
Nissen, who is chairman of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at the Cleveland Clinic’s Sydell and Arnold Miller Family Heart and Vascular Institute, wrote the editorial in response to a retrospective cohort study which found that nearly 30% of more than 28,000 patients who had an adverse reaction to a statin stopped their therapy, and those who stopped were more likely to experience MI, stroke or death at 4 years vs. those who continued statin therapy.
Nissen spoke with Cardiology Today about how misinformation may be driving people to quit statin therapy and what clinicians and others can do to combat it.
Q: What are the most important messages from the study on continuing statin prescriptions after an adverse reaction?
A: This is one of a large group of studies showing that, if statin therapy is stopped for patients with clinical indications for LDL lowering, there is a much worse prognosis.
Q: What prompted you to write your editorial?
A: I wrote this very strong editorial because I wanted to emphasize the extent to which the large amount of unscientific spin about statins being somehow bad for patients has reached the public via a lot of poor-quality internet sites. It has started to affect the quality of care that we can deliver to patients.
Every cardiologist I know sees patients who come in and say, “I don’t want to take a statin. I’ve heard that these drugs are bad for you.” Often, their source is unscientific, cult-like information obtained from the Web. It reminds me a lot of the anti-vaccine campaigns. Many children have been terribly harmed by that movement. It’s part of a larger problem in our country now. We now have climate denial, vaccine denial and statin denial, and it’s as if the country has turned away from good science. Unfortunately, although the internet is a source for much good information, it is also a source for much bad information, and there’s not really a good filter for people.
Q: What are the biggest drivers of low adherence to statin therapy?
A: People taking statins often have some sort of perceived adverse effect. They go online and find a source that claims it’s due to the statin, and they will start to question the wisdom of taking the drug, and often they’ll stop it. That seems to drive a portion of the low adherence. These are drugs that we have studied as well as any drug we administer in medicine. We know what these drugs do. We know that they’re extremely safe and very well-tolerated. Yet, we’re having trouble keeping people on them.
Q: To what extent is bad information impacting adherence to statin therapy?
A: I think it’s greatly impacting it. I also outline in the commentary that we have a law known as the Dietary Supplement Health and Education Act of 1994 (DSHEA). It has been around for more than 20 years and basically takes away the FDA’s regulatory authority over dietary supplements. That resulted in dietary supplements being touted as promoting heart health, often with little or no scientific information, and resulting in public confusion. Some patients decide to stop their statin and take coenzyme Q10 or the latest “hot” supplement.
We also have the rise of cult diets claiming to have extraordinary heart benefits. In my commentary, I cited an article found on the website of Mehmet Oz, MD, MBA, claiming to reverse heart disease in 28 days with a diet. Any reasonable person knows that’s ridiculous, but unfortunately, people are easily convinced.
Q: What can be done to change patients’ perceptions on this topic?
A: Physicians need to be much more proactive about telling people about the scientific facts. It’s the same story as what we did with the anti-vaxxers: We called them out, and pointed out the scientific facts. It’s the same thing we have to do with the movement against climate science. Scientists have to step up.
The media, particularly the mass media, have to do a better job. The medical media have done a good job. The problem is, physicians read publications like Cardiology Today, but members of the public do not. So, the mass media have to step up and tell people the facts.
Q: What else can physicians do to combat the problem?
A: We have to lobby Congress to repeal DSHEA. We need to stop allowing the promotion of worthless products as beneficial for heart health, because it is diverting patients away from medications that they need to avoid this devastating disease. We are not talking about acne. We are talking about the leading cause of death among men and women. We are talking about some of the most effective therapies people have, and we are having trouble getting people to take them because of all this misinformation. We need to get Congress to repeal DSHEA so the FDA can regulate these kinds of claims.
Q: What are some other steps that can be taken?
A: I would like to see the pharmacies do something about the proliferation of dietary supplements. There is shelf after shelf of these products at pharmacies, with a large variety of unsubstantiated health claims. I think ethical pharmacies should not be promoting such products. They should consider not carrying such products. It’s enabling this mismarketing of products that have no health benefits. They can do a better job. – by Erik Swain
For more information:
Steven E. Nissen, MD, MACC, can be reached at nissens@ccf.org.
Disclosure: Nissen reports no relevant financial disclosures.