We can appreciate the push within a newsroom to hammer out a piece like this. Statins are popular, and heart surgeries are common. So a study that captures the intersection of both should have broad appeal to readers.
All the more reason, then, that news outlets should allow reporters to sink a little more time and space into a piece like this. There are interesting details to explore, but very few of them are covered in this four-paragraph piece. An outside expert source, for example, could have provided some perspective on the real-world reasons people stop taking a statin before surgery, and how this plays into what the study found.
Though not stated in this article, it has long been known that statins lower complication rates from heart surgery and are guideline recommended. Thus, it is not clear why these patients were not all taking the medicine. Was it that they were not compliant with doctor recommendations or did a doctor tell them to stop the medicine? Because this study doesn’t know why the patient wasn’t taking the statin, it is difficult to know what to do to address the problem. This would have been an important angle to explore had the story provided more detail.
There is no mention of costs in this story, but statins are not free, nor is heart surgery. A quick note about how much they cost would have been helpful.
The story uses the same quantification of benefits that can be found in the news release about this study. But, fortunately, that information was sufficient to pass this criterion.
The harms of taking a statin are not addressed, even though they carry side effects, and these effects may have been a reason people stopped taking them before surgery.
Also, as implied in the news release from The Society of Thoracic Surgeons, patients may have been told to stop their statins by a doctor–why is that sometimes the case? Was it because of a potential perceived harm? This context isn’t provided.
(It appears, for example, that drug labels for statins used to recommend stopping them before surgery because of the risk of muscle breakdown, known as rhabdomyolysis. There’s some indication that doctors have been slow to catch up with newer guidelines that state statin use should be continued.)
The story does not adequately address the quality of the evidence–and this is a major shortcoming considering the limitations.
Meanwhile, the study itself does a tidy job explaining some of the caveats around the findings. It says, for example, “First, the administration of preoperative statins in our study was neither prospective nor randomized.”
That means that the patients that were analyzed for the study–while large in number–were not analyzed in a randomized, controlled trial that would allow for a more accurate comparison between people taking statins and those not taking statins. Instead, records were reviewed after the fact. For this reason, there may be other factors that explain why the “no statin” patients had an elevated risk of death.
There is no disease mongering in the story. Heart surgery is a common procedure, and while generally also a safe one, it still carries risks, which is why this new data is relevant and interesting.
There are no independent sources quoted in the story. But some perspective from an expert likely would have helped the story by providing some much-needed context on the reasons people may stop taking a statin before surgery, and how to weigh the risks and benefits in light of this new data.
Because there likely are no alternatives to a statin that would be recommended, we’ll rate this N/A.
There is no mention of whether statins are widely available, available by prescription only, etc. We might presume that everyone knows how popular statins are and how widely prescribed, but we always think it’s a good idea to make it clear how someone would gain access to a particular therapy.
A simple line saying something to the effect of “these medicines have been around for many years, are widely used and available in inexpensive generic formulations” would have addressed this.
The novelty of this study was established here, and this appears to be accurate:
“But there’s never before been data saying how harmful stopping shortly before surgery can be. Unless you have some other reason to stop them, you should take statins right up to the morning of surgery.”
This is a barely passing satisfactory because there is a quote from one of the researchers, presumably from an interview, that is not found in the news release.
Otherwise this story contains no information that can’t be found in the 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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