Background: Half of patients with ASCVD do not take statin medications despite proven efficacy and safety. Misinformation about statins drives skepticism about their use. Social media “bots” are known to proliferate misinformation, but involvement in statin-related discourse is unknown. Objectives: 1) to examine temporal trends in volume and sentiment of statin-related Twitter posts (tweets); 2) to compare statin-related content generated by humans and bots Methods: We queried Twitter for all tweets with statin-related terms from 2010-2022. We used a machine learning-derived classifier to determine tweet authorship as bot, human, or intermediate, and natural language processing to assign a sentiment score to each tweet. Manual qualitative analysis was performed on a randomly selected sample of all tweets and highly influential tweets to quantify statin skepticism. Results: We identified 1,155,735 original tweets (excluding retweets) with statin-related terms, the most common being “statin” (n=832,627, 72%) and “Lipitor” (n=197,015, 17%). Bots produced 333,689 (29%), humans produced 699,876 (61%), and intermediate accounts produced 104,966 (9.1%). Over the study period, the proportion of bot tweets decreased from 48% to 11%, human tweets increased from 44% to 80%, and intermediate tweets decreased from 7.7% to 6.7%. The proportion of negative sentiment tweets increased from 28% to 43% for bots, 31% to 38% for humans, and 29% to 40% for intermediate accounts. Including retweets, negative sentiment increased from 30% to 45% across all tweets. In a qualitative analysis of highly influential tweets, statin skepticism increased from 7% to 29% for bots and 25% to 36% for humans. Conclusions: Since 2010, humans have overtaken bots as generators of statin-related content on Twitter. Negative sentiment and statin skepticism have increased, especially among highly influential tweets. Misinformation interventions should focus on human users and influential bots.
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