The consensus around wider statin use has been building, but significant questions remain about costs, long-term risks, and the quality of the evidence supporting wider use. This story focuses on two new studies that address these issues (see here and here). It brings clarity where much of the competing coverage — including a competing piece by NBC — tended to focus on the idea that greater statin use would be a net win for people. While it did a great job overall, the Times piece leaves us with a few lingering questions that we discuss below in the review.
Cardiovascular disease is the leading cause of death in the USA. The number of adults who could potentially be taking statins is very large, and the costs involved very high.
We were surprised to see that a story that covered as much ground as this one did somehow missed costs. The competing story by NBC spelled out the costs.
The story nicely explained that while one of the new studies showed, as expected, that following the updated statin guidelines did increase the number of people who would be treated with statins, following the guidelines would apparently not have saved a significant number of people from dying or having a heart attack or stroke. The story said, “Among the people eligible for statins under the old guidelines, 6.9 percent had a heart attack or stroke or died from coronary disease over the ensuing nine years. Among those eligible for statins under the new guidelines, the figure was 6.3 percent, almost as high. That suggests that the new guidelines do not lead to treatment of many more people who do not need statins.”
At the same time, the story noted that the new guidelines “over all did a better job in discriminating between those who should and should not get statins.” It said that “only 1 percent of participants deemed ineligible for statins under the new guidelines had a heart attack or stroke over nine years, compared with 2.4 percent of those ineligible under the old guidelines.”
While an NBC story also used absolute numbers in talking about the potential benefits in terms of heart attacks, we liked the greater level of context provided in the Times piece. Nevertheless, we think it would have been useful for the Times to include the Number Needed to Treat in its discussion of benefits — this is an easy-to-understand metric that was reported in the study. In addition, we question the Times’s contention that the new criteria “do not lead to treatment of many more people who do not need statins.” According to the study, approximately 94% of both guideline groups did not have a cardiovascular event, and yet the new criteria now extend the use of statins to much larger number of people. In light of such findings, it’s unclear that the new criteria don’t lead to unnecessary treatment for more people as the Time states. We wish the story had explored this result more thoroughly.
We thought that NBC did a better job detailing some of the potential harms from statin use, but we give the Times credit here for framing the story as a discussion of risks vs. benefits and making it clear that experts critical of the new guidelines believe that they “would lead millions of additional people to take statins, exposing them to potential side effects such as muscle pain or damage with little to gain.”
Covering two studies in little more than 1,000 words is already a feat. Doing so while bringing in enough context to explain the caveats to the study is an order of magnitude greater. Compared to the NBC piece, the Times did a superior job showing that, despite the enthusiasm in some quarters of the scientific community, the two studies did not settle the debate over whether statins should be more widely prescribed.
The story did not engage in disease mongering.
The story sought out and made good use of independent sources. It mentions that the guidelines were widely criticized and links to some printed criticisms made at the time. It quotes a variety of supportive and critical researchers regarding their opinions on the new research.
The story did not make any reference to dietary changes, lifestyle changes, or exercise.
The story made it clear that statins are widely prescribed. One in four Americans take them by some estimates.
The story established that the findings of the studies were not novel but rather were in keeping with earlier findings about statins.
Because it contains comments from independent experts, we can be sure the story did not rely excessively on any news release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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