Seven years ago, the TV journalist Maryanne Demasi broadcast the episode “Heart of the Matter”, on the ABC. This Catalyst episode queried the link between cholesterol, cholesterol-reducing medication (commonly known as statins and with brand names like Lipitor and Crestor), and ill-health. The TV show had US experts of dubious repute that did not declare their commercial conflicts with herbal cholesterol lowering tablets.
Much has been written on the impact of this TV show on the use of these medications. One study estimated 60,000 less Australians look cholesterol lowering medication after the program went to air. Andrea Schaffer, from the University of Sydney said that if individuals “continue to be non-adherent, this could result in between 1,522 and 2,900 preventable, and potentially fatal, major vascular events.”
In fairness to Maryanne Demasi and the ABC, the program focused on low risk patients without coronary disease rather than high risk patients with coronary disease, however this message may have been too subtle for the average person.
Ochre Health, as part of its normal operations collects de-identified patient data on key health indicators, and this includes the percentage of patients that are prescribed cholesterol lowering medication and cholesterol levels. We only collect this data on people with established Coronary Heart Disease (CHD), which is more commonly referred to as angina and heart attacks. Coronary disease is the number one cause of death in Australia and all patients with CHD should take medication if their total cholesterol is above the target of 4 mmol/l.
Lets look at our data collection in the Western NSW towns of Bourke, Brewarrina, Lightning Ridge, Collarenebri, Coonamble, and Condobolin. Overall, we had a sample of 702 patients with established CHD and this included 246 people (35%) who identified as Aboriginal. Our data was not being collected as part of a study, and was being used for quality improvement.
Graph: Cholesterol lowering medication and Cholesterol (lipid) levels
As you can see in the graph we had a period of slow improvement in prescribing in the 15 months prior to the TV episode airing and this reached a peak in October 2013. At that point we had 79% of Aboriginal people, and 75% of all people taking cholesterol lowering medication.
Although patients with coronary disease are high risk and should take medication, some patients will have side effects, refuse medication, or have doctors that have not recommended it. Therefore 75 – 79% is an excellent result and is consistent with the levels of cholesterol lowering medication seen in Sydney and Melbourne.
After the “The Heart of the Matter” went to air we saw a trend to lower percentages of prescribing. All up there was an 8% drop in over the next 12 months. We continued to collect data until the end of 2015, and saw some improvement, but never back to the levels seen in October 2013.
So, it seems reasonable to say that the TV show “Heart of the Matter” reduced cholesterol lowering medication use for patients with coronary disease in Western NSW, and despite our best efforts we were unable to fully prevent this decline.
Now this is where things get curious. With lower prescribing rates we would expect that more people with coronary disease would fail to meet their cholesterol or lipid targets. However, what we find is the opposite, and the percentage of patients meeting their cholesterol target continued to improve. In fact twelve months later in October 2014, the percentage of patients with coronary disease meeting their cholesterol target had increased by 15% (33% to 38%) and medication had fallen by 8% (from 75% down to 69%). For Aboriginal patients there was no change in the percentage meeting their cholesterol target and there was a 9% fall in medication prescribing.
What is happening here? The short answer is we do not know. Maybe the controversy made people with coronary disease more aware of lipid levels as an important risk factor and they improved their medication compliance and their diet?
Maybe the people that ceased their medication were the people that were not meeting their lipid target and therefore ceasing had no impact on the overall percentage?
The negative publicity could have given people who didn’t fill their scripts for cholesterol lowering medications permission to say no to receiving further scripts and again this would make no difference to clinical outcomes.
What it does show is that there are complicated relationships between cause and effect, and in this case the prescribing data does not match the clinical outcome data.
And how did things work out for Maryanne Demasi? Not so well. In 2016 she was suspended for breaching the ABC’s impartiality guidelines for linking Wi-Fi and mobile phones with cancer and other health risks in the Catalyst episode “Wi-Fried”.