Short communication| Volume 262, P25-27, July 01, 2018

Does Googling lead to statin intolerance?


      • English-speaking countries have the largest number of websites about statin side effects.
      • The number of websites about statin side effects in a country was correlated with its prevalence of statin intolerance.
      • The nocebo effect driven by internet searches may be contributing to statin intolerance.



      The nocebo effect, where patients with expectations of adverse effects are more likely to experience them, may contribute to the high rate of statin intolerance found in observational studies. Information that patients read on the internet may be a precipitant of this effect. The objective of the study was to establish whether the number of websites about statin side effects found using Google is associated with the prevalence of statin intolerance.


      The prevalence of statin intolerance in 13 countries across 5 continents was established in a recent study via a web-based survey of primary care physicians and specialists. Using the Google search engine for each country, the number of websites about statin side effects was determined, and standardized to the number of websites about statins overall. Searches were restricted to pages in the native language, and were conducted after connecting to each country using a virtual private network (VPN).


      English-speaking countries (Australia, Canada, UK, USA) had the highest prevalence of statin intolerance and also had the largest standardized number of websites about statin side effects. The sample Pearson correlation coefficient between these two variables was 0.868.


      Countries where patients using Google are more likely to find websites about statin side effects have greater levels of statin intolerance. The nocebo effect driven by online information may be contributing to statin intolerance.


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        • Cholesterol Treatment Trialists' (CTT) Collaborators
        Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins.
        Lancet. 2008; 366: 1267-1278
        • Cholesterol Treatment Trialists' (CTT) Collaboration
        Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials.
        Lancet. 2010; 376: 1670-1681
        • Cholesterol Treatment Trialists' (CTT) Collaboration
        The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials.
        Lancet. 2012; 380: 581-590
        • Collins R.
        • Reith C.
        • Emberson J.
        • Armitage J.
        • Baigent C.
        • Blackwell L.
        • Blumenthal R.
        • Danesh J.
        • Smith G.D.
        • DeMets D.
        • Evans S.
        • Law M.
        • MacMahon S.
        • Martin S.
        • Neal B.
        • Poulter N.
        • Preiss D.
        • Ridker P.
        • Roberts I.
        • Rodgers A.
        • Sandercock P.
        • Schulz K.
        • Sever P.
        • Simes J.
        • Smeeth L.
        • Wald N.
        • Yusuf S.
        • Peto R.
        Interpretation of the evidence for the efficacy and safety of statin therapy.
        Lancet. 2016; 388: 2532-2561
        • Tobert J.A.
        • Newman C.B.
        The nocebo effect in the context of statin intolerance.
        J. Clin. Lipidol. 2016; 10: 739-747
        • Zhang H.
        • Plutzky J.
        • Skentzos S.
        • Morrison F.
        • Mar P.
        • Shubina M.
        • Turchin A.
        Discontinuation of statins in routine care settings: a cohort study.
        Ann. Intern. Med. 2013; 158: 526-534
        • Barsky A.J.
        • Saintfort R.
        • Rogers M.P.
        • Borus J.F.
        Nonspecific medication side effects and the nocebo phenomenon.
        JAMA. 2002; 287: 622-627
        • Gupta A.
        • Thompson D.
        • Whitehouse A.
        • Collier T.
        • Dahlof B.
        • Poulter N.
        • Collins R.
        • Sever P.
        Adverse events associated with unblinded, but not with blinded, statin therapy in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm (ASCOT-LLA): a randomised double-blind placebo-controlled trial and its non-randomised non-blind extension phase.
        Lancet. 2017;
        • Crichton F.
        • Petrie K.J.
        Accentuate the positive: counteracting psychogenic responses to media health messages in the age of the Internet.
        J. Psychosom. Res. 2015; 79: 185-189
        • Nissen S.E.
        Statin denial: an internet-driven cult with deadly consequences.
        Ann. Intern. Med. 2017; 167: 281-282
        • Hovingh G.K.
        • Gandra S.R.
        • McKendrick J.
        • Dent R.
        • Wieffer H.
        • Catapano A.L.
        • Oh P.
        • Rosenson R.S.
        • Stroes E.S.
        Identification and management of patients with statin-associated symptoms in clinical practice: a clinician survey.
        Atherosclerosis. 2016; 245: 111-117
        • OECD
        Health at a Glance 2015: OECD Indicators.
        OECD Publishing, Paris2015
        • Faasse K.
        • Petrie K.J.
        The nocebo effect: patient expectations and medication side effects.
        Postgrad. Med. J. 2013; 89: 540
        • Silvestri A.
        • Galetta P.
        • Cerquetani E.
        • Marazzi G.
        • Patrizi R.
        • Fini M.
        • Rosano G.M.C.
        Report of erectile dysfunction after therapy with beta-blockers is related to patient knowledge of side effects and is reversed by placebo.
        Eur. Heart J. 2003; 24: 1928-1932
        • Weissenfeld J.
        • Stock S.
        • Lüngen M.
        • Gerber A.
        The nocebo effect: a reason for patients' non-adherence to generic substitution?.
        Pharmazie. 2010; 65: 451-456
        • Johnston A.
        Challenges of therapeutic substitution of drugs for economic reasons: focus on CVD prevention.
        Curr. Med. Res. Opin. 2010; 26: 871-878
        • Faasse K.
        • Gamble G.
        • Cundy T.
        • Petrie K.J.
        Impact of television coverage on the number and type of symptoms reported during a health scare: a retrospective pre-post observational study.
        BMJ Open. 2012; 2
        • 2015 search engine market share by country
        • Crum A.
        • Zuckerman B.
        Changing mindsets to enhance treatment effectiveness.
        JAMA. 2017; 317: 2063-2064
        • Bingel U.
        Avoiding nocebo effects to optimize treatment outcome.
        JAMA. 2014; 312: 693-694

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