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Statins popularity: A global picture

2019; Wiley; Volume: 85; Issue: 7 Linguagem: Inglês

10.1111/bcp.13944

1365-2125

Giuseppe Lippi, Camilla Mattiuzzi, Gianfranco Cervellin,

Pharmaceutical Economics and Policy

Statins are a class of cholesterol-lowering drugs which act inhibiting the enzyme 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase and are commonly used for preventing or treating cardiovascular diseases.1, 2 More recently, evidence has been provided that these drugs may also have a small protective effect against venous thromboembolism in some forms of cancer.3 Lovastatin has been the first of these agents to be used for lowering low density lipoprotein cholesterol (LDL-C) approximately 40 years ago. Since then, many other similar drugs have been produced and commercialized, each differing for chemical structure, biological properties, efficacy, safety, and side effects.1 In a recent article published in this journal, Blais et al reported on the current trend of prescription of statins in Hong Kong4 and concluded that simvastatin was the most prescribed drug, followed by atorvastatin and rosuvastatin, whilst lovastatin, fluvastatin, and pravastatin altogether accounted for <8% of the total usage. Little is known, however, on the popularity of these different statins around the world. Google Trends (Google Inc. Mountain View, CA, US) has been advocated as reliable means for assessing the popularity of many health care topics among Internet users.5 This freely searchable Internet-based software allows to analyze the popularity of specific search queries in Google Search across many different regions, providing a final output (ie, the Google Trend score) which classifies the popularity of a certain search term among Internet users. In order to garner information on the worldwide popularity of statins, an electronic search was performed using Google Trends over the past 15 years (ie, between January 2004 and December 2018), without geographical restrictions, and using the following search terms: "atorvastatin" OR "simvastatin" OR "rosuvastatin" OR "pravastatin" OR "lovastatin" OR "fluvastatin" OR "pitavastatin." The mean monthly Google Trends score, reflecting the mean number of monthly Google searches for these drugs, was then calculated, according with its relative standard deviation (SD). The trend of Google searches (ie, monthly Google Trends score) for the different types of statins is illustrated in Figure 1. Overall, atorvastatin has been the most worldwide searched agent in the past 15 years (58 ± 14; 39% of total), followed by simvastatin (39 ± 7; 26%), rosuvastatin (28 ± 7; 19%), pravastatin (13 ± 2; 8%), lovastatin (7 ± 3; 5%), fluvastatin (3 ± 2; 2%), and pitavastatin (2 ± 1; 1%). The situation has only slightly changed in the past 3 years, with atorvastatin remaining the most searched agent worldwide (63±; 44%), followed by rosuvastatin (31 ± 4; 22%), simvastatin (29 ± 2; 21%), pravastatin (11 ± 1; 8%), lovastatin (4 ± 1; 3%), pitavastatin (3 ± 1; 2%), and fluvastatin (1 ± 1; 1%). It has been now demonstrated that the Google Trends score reliably reflects the relative popularity over time of searches for many diseases and drugs.6 Although this tool can also be used by physicians, recent surveys suggest that nearly 80% of the Internet users have used it for searching online information on medical conditions and other health-related topics.6 The results of our analysis partially confirm the data published by Blais et al4 and suggest that atorvastatin is the most popular searched statin around the world. Albeit the popularity of this drug has apparently declined among Internet users between 2004 and 2013, the number of Google searches has then displayed a notable increase afterward, more pronounced in the past 3 years. Regarding the other statins, rosuvastatin and simvastatin have exhibited an opposite trend during the past 15 years (Figure 1), with the former drug now appearing more popular than the latter. The popularity of the other four drugs has instead remained very marginal during the past 15 years, altogether accounting for less than 16% of all Google searches. Indeed, continuous monitoring would be needed to identify variations of drugs usage over time. There are no competing interests to declare.