Statin Twitter: Human and Automated Bot Contributions, 2010 to 2022

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Abstract

Background

Many individuals eligible for statin therapy decline treatment, often due to fear of adverse effects. Misinformation about statins is common and drives statin reluctance, but its prevalence on social media platforms, such as Twitter (now X) remains unclear. Social media bots are known to proliferate medical misinformation, but their involvement in statin‐related discourse is unknown. This study examined temporal trends in volume, author type (bot or human), and sentiment of statin‐related Twitter posts (tweets).

Methods and Results

We analyzed original tweets with statin‐related terms from 2010 to 2022 using a machine learning–derived classifier to determine the author's bot probability, natural language processing to assign each tweet a negative or positive sentiment, and manual qualitative analysis to identify statin skepticism in a random sample of all tweets and in highly influential tweets. We identified 1 155 735 original statin‐related tweets. Bots produced 333 689 (28.9%), humans produced 699 876 (60.6%), and intermediate probability accounts produced 104 966 (9.1%). Over time, the proportion of bot tweets decreased from 47.8% to 11.3%, and human tweets increased from 43.6% to 79.8%. The proportion of negative‐sentiment tweets increased from 27.8% to 43.4% for bots and 30.9% to 38.4% for humans. Manually coded statin skepticism increased from 8.0% to 19.0% for bots and from 26.0% to 40.0% for humans.

Conclusions

Over the past decade, humans have overtaken bots as generators of statin‐related content on Twitter. Negative sentiment and statin skepticism have increased across all user types. Twitter may be an important forum to combat statin‐related misinformation.

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Most cited references 37

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Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170 000 participants in 26 randomised trials

Cholesterol Treatment Trialists' (CTT) Collaboration, Aldo Pietro Maggioni (2011)

Summary Background Lowering of LDL cholesterol with standard statin regimens reduces the risk of occlusive vascular events in a wide range of individuals. We aimed to assess the safety and efficacy of more intensive lowering of LDL cholesterol with statin therapy. Methods We undertook meta-analyses of individual participant data from randomised trials involving at least 1000 participants and at least 2 years' treatment duration of more versus less intensive statin regimens (five trials; 39 612 individuals; median follow-up 5·1 years) and of statin versus control (21 trials; 129 526 individuals; median follow-up 4·8 years). For each type of trial, we calculated not only the average risk reduction, but also the average risk reduction per 1·0 mmol/L LDL cholesterol reduction at 1 year after randomisation. Findings In the trials of more versus less intensive statin therapy, the weighted mean further reduction in LDL cholesterol at 1 year was 0·51 mmol/L. Compared with less intensive regimens, more intensive regimens produced a highly significant 15% (95% CI 11–18; p<0·0001) further reduction in major vascular events, consisting of separately significant reductions in coronary death or non-fatal myocardial infarction of 13% (95% CI 7–19; p<0·0001), in coronary revascularisation of 19% (95% CI 15–24; p<0·0001), and in ischaemic stroke of 16% (95% CI 5–26; p=0·005). Per 1·0 mmol/L reduction in LDL cholesterol, these further reductions in risk were similar to the proportional reductions in the trials of statin versus control. When both types of trial were combined, similar proportional reductions in major vascular events per 1·0 mmol/L LDL cholesterol reduction were found in all types of patient studied (rate ratio [RR] 0·78, 95% CI 0·76–0·80; p<0·0001), including those with LDL cholesterol lower than 2 mmol/L on the less intensive or control regimen. Across all 26 trials, all-cause mortality was reduced by 10% per 1·0 mmol/L LDL reduction (RR 0·90, 95% CI 0·87–0·93; p<0·0001), largely reflecting significant reductions in deaths due to coronary heart disease (RR 0·80, 99% CI 0·74–0·87; p<0·0001) and other cardiac causes (RR 0·89, 99% CI 0·81–0·98; p=0·002), with no significant effect on deaths due to stroke (RR 0·96, 95% CI 0·84–1·09; p=0·5) or other vascular causes (RR 0·98, 99% CI 0·81–1·18; p=0·8). No significant effects were observed on deaths due to cancer or other non-vascular causes (RR 0·97, 95% CI 0·92–1·03; p=0·3) or on cancer incidence (RR 1·00, 95% CI 0·96–1·04; p=0·9), even at low LDL cholesterol concentrations. Interpretation Further reductions in LDL cholesterol safely produce definite further reductions in the incidence of heart attack, of revascularisation, and of ischaemic stroke, with each 1·0 mmol/L reduction reducing the annual rate of these major vascular events by just over a fifth. There was no evidence of any threshold within the cholesterol range studied, suggesting that reduction of LDL cholesterol by 2–3 mmol/L would reduce risk by about 40–50%. Funding UK Medical Research Council, British Heart Foundation, European Community Biomed Programme, Australian National Health and Medical Research Council, and National Heart Foundation.

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Interpretation of the evidence for the efficacy and safety of statin therapy.

Rory Collins, Christina Reith, Jonathan Emberson … (2016)

This Review is intended to help clinicians, patients, and the public make informed decisions about statin therapy for the prevention of heart attacks and strokes. It explains how the evidence that is available from randomised controlled trials yields reliable information about both the efficacy and safety of statin therapy. In addition, it discusses how claims that statins commonly cause adverse effects reflect a failure to recognise the limitations of other sources of evidence about the effects of treatment. Large-scale evidence from randomised trials shows that statin therapy reduces the risk of major vascular events (ie, coronary deaths or myocardial infarctions, strokes, and coronary revascularisation procedures) by about one-quarter for each mmol/L reduction in LDL cholesterol during each year (after the first) that it continues to be taken. The absolute benefits of statin therapy depend on an individual's absolute risk of occlusive vascular events and the absolute reduction in LDL cholesterol that is achieved. For example, lowering LDL cholesterol by 2 mmol/L (77 mg/dL) with an effective low-cost statin regimen (eg, atorvastatin 40 mg daily, costing about £2 per month) for 5 years in 10 000 patients would typically prevent major vascular events from occurring in about 1000 patients (ie, 10% absolute benefit) with pre-existing occlusive vascular disease (secondary prevention) and in 500 patients (ie, 5% absolute benefit) who are at increased risk but have not yet had a vascular event (primary prevention). Statin therapy has been shown to reduce vascular disease risk during each year it continues to be taken, so larger absolute benefits would accrue with more prolonged therapy, and these benefits persist long term. The only serious adverse events that have been shown to be caused by long-term statin therapy-ie, adverse effects of the statin-are myopathy (defined as muscle pain or weakness combined with large increases in blood concentrations of creatine kinase), new-onset diabetes mellitus, and, probably, haemorrhagic stroke. Typically, treatment of 10 000 patients for 5 years with an effective regimen (eg, atorvastatin 40 mg daily) would cause about 5 cases of myopathy (one of which might progress, if the statin therapy is not stopped, to the more severe condition of rhabdomyolysis), 50-100 new cases of diabetes, and 5-10 haemorrhagic strokes. However, any adverse impact of these side-effects on major vascular events has already been taken into account in the estimates of the absolute benefits. Statin therapy may cause symptomatic adverse events (eg, muscle pain or weakness) in up to about 50-100 patients (ie, 0·5-1·0% absolute harm) per 10 000 treated for 5 years. However, placebo-controlled randomised trials have shown definitively that almost all of the symptomatic adverse events that are attributed to statin therapy in routine practice are not actually caused by it (ie, they represent misattribution). The large-scale evidence available from randomised trials also indicates that it is unlikely that large absolute excesses in other serious adverse events still await discovery. Consequently, any further findings that emerge about the effects of statin therapy would not be expected to alter materially the balance of benefits and harms. It is, therefore, of concern that exaggerated claims about side-effect rates with statin therapy may be responsible for its under-use among individuals at increased risk of cardiovascular events. For, whereas the rare cases of myopathy and any muscle-related symptoms that are attributed to statin therapy generally resolve rapidly when treatment is stopped, the heart attacks or strokes that may occur if statin therapy is stopped unnecessarily can be devastating.

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Weaponized Health Communication: Twitter Bots and Russian Trolls Amplify the Vaccine Debate

Mark Dredze, Amelia M. Jamison, SiHua Qi … (2018)

Objectives. To understand how Twitter bots and trolls (“bots”) promote online health content. Methods. We compared bots’ to average users’ rates of vaccine-relevant messages, which we collected online from July 2014 through September 2017. We estimated the likelihood that users were bots, comparing proportions of polarized and antivaccine tweets across user types. We conducted a content analysis of a Twitter hashtag associated with Russian troll activity. Results. Compared with average users, Russian trolls (χ 2 (1) = 102.0; P < .001), sophisticated bots (χ 2 (1) = 28.6; P < .001), and “content polluters” (χ 2 (1) = 7.0; P < .001) tweeted about vaccination at higher rates. Whereas content polluters posted more antivaccine content (χ 2 (1) = 11.18; P < .001), Russian trolls amplified both sides. Unidentifiable accounts were more polarized (χ 2 (1) = 12.1; P < .001) and antivaccine (χ 2 (1) = 35.9; P < .001). Analysis of the Russian troll hashtag showed that its messages were more political and divisive. Conclusions. Whereas bots that spread malware and unsolicited content disseminated antivaccine messages, Russian trolls promoted discord. Accounts masquerading as legitimate users create false equivalency, eroding public consensus on vaccination. Public Health Implications. Directly confronting vaccine skeptics enables bots to legitimize the vaccine debate. More research is needed to determine how best to combat bot-driven content.

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Author and article information

Contributors

Samuel D. Slavin:

ORCID: https://orcid.org/0000-0002-7208-1351

sslavin@mgb.org

Journal

Journal ID (nlm-ta): J Am Heart Assoc

Journal ID (iso-abbrev): J Am Heart Assoc

Journal ID (doi): 10.1002/(ISSN)2047-9980

Journal ID (publisher-id): JAH3

Journal ID (hwp): ahaoa

Title: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Electronic): 2047-9980

Publication date (Electronic): 27 March 2024

Publication date Collection: 02 April 2024

Volume: 13

Issue: 7 ( doiID: 10.1002/jah3.v13.7 )

Electronic Location Identifier: e032678

Affiliations

[ ¹ ] Brigham and Women’s Hospital Boston MA USA

[ ² ] Harvard T.H. Chan School of Public Health Boston MA USA

[ ³ ] UT Southwestern Medical Center Dallas TX USA

[ ⁴ ] Beth Israel Deaconess Medical Center Boston MA USA

Author notes

[*] [* ] Correspondence to: Samuel D. Slavin, MD, Brigham and Women's Hospital, Division of Cardiovascular Medicine, 70 Francis Street, Boston, MA 02115. Email: sslavin@ 123456mgb.org

[*]

A. M. Navar and M. A. Mittleman contributed equally as co‐senior authors.

Author information

Samuel D. Slavin https://orcid.org/0000-0002-7208-1351

Adam N. Berman https://orcid.org/0000-0002-0724-9779

Andrew L. Beam https://orcid.org/0000-0002-6657-2787

Ann Marie Navar https://orcid.org/0000-0002-6197-9860

Murray A. Mittleman https://orcid.org/0000-0001-9788-7274

Article

Publisher ID: JAH39201 Other ID: JAHA/2023/032678-T

DOI: 10.1161/JAHA.123.032678

PMC ID: 11179764

PubMed ID: 38533942

SO-VID: 6ff826df-1fef-42ec-9a35-077da2893999

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

History

Date received : 12 October 2023

Date accepted : 06 December 2023

Page count

Figures: 5, Tables: 2, Pages: 11, Words: 5380

Funding

Funded by: National Institutes of Health , doi 10.13039/100000002;

Award ID: T32HL007604

Custom metadata

source-schema-version-number 2.0

cover-date 02 April 2024

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.4.0 mode:remove_FC converted:02.04.2024

ScienceOpen disciplines: Cardiovascular Medicine

Keywords: cardiovascular prevention,misinformation,social media,statins,digital health,epidemiology,cardiovascular disease,primary prevention,secondary prevention

Data availability:

ScienceOpen disciplines: Cardiovascular Medicine

Keywords: cardiovascular prevention, misinformation, social media, statins, digital health, epidemiology, cardiovascular disease, primary prevention, secondary prevention

Statin Twitter: Human and Automated Bot Contributions, 2010 to 2022

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Background

Methods and Results

Conclusions

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The Science of Twitter

Most cited references 37

Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170 000 participants in 26 randomised trials

Interpretation of the evidence for the efficacy and safety of statin therapy.

Weaponized Health Communication: Twitter Bots and Russian Trolls Amplify the Vaccine Debate

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