Personalized absolute benefit of statin treatment for primary or secondary prevention of vascular disease in individual elderly patients

Stam-Slob, M. C. et al. (2017) Personalized absolute benefit of statin treatment for primary or secondary prevention of vascular disease in individual elderly patients. Clinical Research in Cardiology, 106(1), pp. 58-68. (doi: 10.1007/s00392-016-1023-8) (PMID:27554244) (PMCID:PMC5226996)

Abstract

Objective: To estimate the absolute treatment effect of statin therapy on major adverse cardiovascular events (MACE; myocardial infarction, stroke and vascular death) for the individual patient aged ≥70 years. Methods: Prediction models for MACE were derived in patients aged ≥70 years with (n = 2550) and without (n = 3253) vascular disease from the “PROspective Study of Pravastatin in Elderly at Risk” (PROSPER) trial and validated in the “Secondary Manifestations of ARTerial disease” (SMART) cohort study (n = 1442) and the “Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm” (ASCOT-LLA) trial (n = 1893), respectively, using competing risk analysis. Prespecified predictors were various clinical characteristics including statin treatment. Individual absolute risk reductions (ARRs) for MACE in 5 and 10 years were estimated by subtracting on-treatment from off-treatment risk. Results: Individual ARRs were higher in elderly patients with vascular disease [5-year ARRs: median 5.1 %, interquartile range (IQR) 4.0–6.2 %, 10-year ARRs: median 7.8 %, IQR 6.8–8.6 %] than in patients without vascular disease (5-year ARRs: median 1.7 %, IQR 1.3–2.1 %, 10-year ARRs: 2.9 %, IQR 2.3–3.6 %). Ninety-eight percent of patients with vascular disease had a 5-year ARR ≥2.0 %, compared to 31 % of patients without vascular disease. Conclusions: With a multivariable prediction model the absolute treatment effect of a statin on MACE for individual elderly patients with and without vascular disease can be quantified. Because of high ARRs, treating all patients is more beneficial than prediction-based treatment for secondary prevention of MACE. For primary prevention of MACE, the prediction model can be used to identify those patients who benefit meaningfully from statin therapy.

• Item Type: Articles
• Additional Information: This work was financially supported by ZonMw, the Netherlands Organization for Health Research and Development (Grant No. 836011027).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Macfarlane, Professor Peter and Sattar, Professor Naveed
• Authors: Stam-Slob, M. C., Visseren, F. L.J., Wouter Jukema, J., van der Graaf, Y., Poulter, N. R., Gupta, A., Sattar, N., Macfarlane, P. W., Kearney, P. M., de Craen, A. J.M., and Trompet, S.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Clinical Research in Cardiology
• Publisher: Springer
• ISSN: 1861-0684
• ISSN (Online): 1861-0692
• Published Online: 23 August 2016
• Copyright Holders: Copyright © 2016 The Authors
• First Published: First published in Clinical Research in Cardiology 106(1): 58-68
• Publisher Policy: Reproduced under a Creative Commons License