Television advertising may drive over-diagnosis of high cholesterol and over-treatment with statins, according to a new study by Dr. Jeff Niederdeppe from Cornell University in the US and colleagues. It appears that a trip to the doctor enquiring about statins advertised on TV often leads to a prescription. The work appears online in the Journal of General Internal Medicine, published by Springer.

Coronary heart disease is the leading cause of death in the US, and high levels of LDL-cholesterol, or 'bad' cholesterol, are a major contributor. Statins have been proven to reduce LDL-cholesterol, but do they also have a role to play in the primary prevention of coronary heart disease? The jury is still out.

Statins are advertised on television with the aim of educating the population about health risks and encouraging people to seek medical advice, relevant diagnostic tests and appropriate treatment. Niederdeppe and colleagues explored whether exposure to direct-to-consumer advertising of statins was related to high cholesterol diagnosis and statin use among men and women at high, moderate, or low risk for future cardiac events.

The authors looked at how often 106,685 American adults were potentially exposed to direct-to- consumer advertising of statin drugs on national, cable and local television between 2001-2007. They also gathered data on whether participants reported being diagnosed with high cholesterol, whether or not they had taken a statin in the previous year, as well as their risk factors for coronary heart disease.

Their analyses suggest that those adults who had been exposed to statin ads were 16 to 20 percent more likely to be diagnosed with high cholesterol, and 16 to 22 percent more likely to be using statins. Interestingly, the likelihood of both a diagnosis of high cholesterol and increased statin use was driven almost exclusively by men and women at low risk for future cardiac events. Conversely, those at high risk of heart disease exposed to statin ads on TV were not more likely to be taking a statin.

The authors conclude: "Our findings raise questions about the extent to which direct-to-consumer advertising may promote over-diagnosis and over-treatment for populations where risks may outweigh potential benefits. In addition, we found no evidence of favorable associations between exposure to statins in television advertisements and statin use among those at high risk for future cardiac events."

Niederdeppe J et al (2013). Direct-to-consumer television advertising exposure, diagnosis with high cholesterol, and statin use. Journal of General Internal Medicine; DOI 10.1007/s11606-013-2379-3