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

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.

• Authors: Manon C Stam-Slob, Frank L J Visseren, J Wouter Jukema, Yolanda van der Graaf, Neil R Poulter, Ajay Gupta, Naveed Sattar, Peter W Macfarlane, Patricia M Kearney, Anton J M de Craen, Stella Trompet
• Journal: Clinical research in cardiology : official journal of the German Cardiac Society (Clin Res Cardiol) Vol. 106 Issue 1 Pg. 58-68 (Jan 2017) ISSN: 1861-0692 [Electronic] Germany
• PMID: 27554244 (Publication Type: Journal Article, Validation Study)

Chemical References

• Biomarkers
• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• Lipids

Topics

• Age Factors
• Aged
• Aged, 80 and over
• Biomarkers (blood)
• Cardiovascular Diseases (etiology, mortality, prevention & control)
• Decision Support Techniques
• Dyslipidemias (blood, complications, drug therapy, mortality)
• Female
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (adverse effects, therapeutic use)
• Lipids (blood)
• Male
• Models, Statistical
• Multicenter Studies as Topic
• Multivariate Analysis
• Observational Studies as Topic
• Predictive Value of Tests
• Primary Prevention (methods)
• Randomized Controlled Trials as Topic
• Recurrence
• Reproducibility of Results
• Risk Assessment
• Risk Factors
• Secondary Prevention (methods)
• Time Factors
• Treatment Outcome