Byrne

Niederdeppe

Direct-to-consumer advertising of cholesterol medications may promote overdiagnosis and overtreatment among low-risk populations, reports a new Cornell study, while high-risk consumers do not seem to get the message.

Specifically, men and women who were exposed to statin (cholesterol-lowering medications) ads were 16-20 percent more likely to be diagnosed with high cholesterol, and 16-22 percent more likely to use statins than those people not exposed to advertising. These associations were driven almost exclusively, however, by men and women at low risk for future cardiac events, said study leader Jeff Niederdeppe, Cornell assistant professor of communication.

The results are of particular concern for women who are at high risk, especially those with coronary heart disease, diabetes or a previous heart attack, and not routinely screened. High-risk women who were heavily exposed to pharmaceutical ads for statins were less likely to use them, Niederdeppe reports in the online article "Effects of Direct-to-Consumer Television Advertising on High Cholesterol Diagnosis and Statin Use," in the Journal of General Internal Medicine, March 8.

"Results indicate that direct-to-consumer advertising exposure does not appear to be linked to a greater likelihood of cholesterol diagnosis or statin use among those at the greatest risk for future cardiac events, for whom there is an established benefit," Niederdeppe said.

He and co-authors Sahara Byrne, Cornell assistant professor of communication, and Rosemary Avery, professor and chair of Cornell's Department of Policy Analysis and Management, and former graduate student Jonathan Cantor '10, M.S. '11, of New York University, analyzed data from nearly 107,000 respondents to a National Consumer Survey and advertising statistics from 2001 to 2007.

Coronary heart disease is the leading cause of death in the United States, and high levels of LDL-cholesterol, or "bad" cholesterol, are a major contributor. Statins have been proven to reduce LDL-cholesterol, but some studies have suggested that patients who use statins as a method of primary prevention may also develop other serious adverse health effects. These adverse effects offset many of their benefits, particularly for groups at relatively low risk for future cardiac events, Niederdeppe said.

Often, cholesterol can be controlled by diet and exercise, and most doctors agree that lifestyle change should occur before pharmaceutical intervention. In a separate study, "When Diet and Exercise Are Not Enough," published online Feb. 27 in the journal Health Communication, the Cornell team found that nearly two-thirds of direct-to-consumer advertisements do not provide information about behavioral alternatives to medication. Furthermore, many ads made direct claims refuting the value of lifestyle change.

"In fact, the ads tend to offer, at best, mixed messages about the efficacy of diet and exercise in reducing cholesterol and risk of heart disease," said lead author Byrne. "One wonders if exposure to common arguments in the ad such as 'when diet and exercise are not enough -- take this drug' will motivate people to skip over the lifestyle change and go straight to the drug."

Byrne advises doctors to consider this context when approached by patients inquiring about statins. She also suggests that the medical industry amend its advertising guidelines to encourage advertisers to be more precise about the medical consensus on the role of lifestyle modification treatment.

The studies were funded by the National Institutes of Health, the Substance Abuse Policy Research Program of the Robert Wood Johnson Foundation, and the Merck Company Foundation.

Stacey Shackford is staff writer for the College of Agriculture and Life Sciences.