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

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dc.contributor.author Stam-Slob, Manon C.
dc.contributor.author Visseren, Frank L. J.
dc.contributor.author Jukema, J. Wouter
dc.contributor.author van der Graaf, Yolanda
dc.contributor.author Poulter, Neil R.
dc.contributor.author Gupta, Ajay
dc.contributor.author Sattar, Naveed
dc.contributor.author Macfarlane, Peter W.
dc.contributor.author Kearney, Patricia M.
dc.contributor.author de Craen, Anton J. M.
dc.contributor.author Trompet, Stella
dc.date.accessioned 2016-09-23T08:13:53Z
dc.date.available 2016-09-23T08:13:53Z
dc.date.issued 2016-08-23
dc.identifier.citation Stam-Slob, M.C., Visseren, F.L., Jukema, J.W., van der Graaf, Y., Poulter, N.R., Gupta, A., Sattar, N., Macfarlane, P.W., Kearney, P.M., de Craen, A.J. and Trompet, S. (2016)'Personalized absolute benefit of statin treatment for primary or secondary prevention of vascular disease in individual elderly patients', Clinical Research in Cardiology, pp.1-11. doi: 10.1007/s00392-016-1023-8 en
dc.identifier.startpage 1 en
dc.identifier.endpage 11 en
dc.identifier.issn 1861-0684
dc.identifier.uri http://hdl.handle.net/10468/3112
dc.identifier.doi 10.1007/s00392-016-1023-8
dc.description.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 C70 years. Methods: Prediction models for MACE were derived in patients aged C70 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 ontreatment 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 %). Ninetyeight percent of patients with vascular disease had a 5-year ARR C2.0 %, 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. en
dc.description.sponsorship ZonMw, the Netherlands (Grant No. 836011027) en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher Springer International Publishing en
dc.rights © 2016, the Authors. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. en
dc.rights.uri http://creativecommons.org/licenses/by/4.0/ en
dc.subject Elderly en
dc.subject Statin en
dc.subject Absolute treatment effect en
dc.subject Vascular disease en
dc.title Personalized absolute benefit of statin treatment for primary or secondary prevention of vascular disease in individual elderly patients en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Patricia Kearney, Epidemiology and Public Health, University College Cork, Cork, Ireland. +353-21-490-3000 Email: patricia.kearney@ucc.ie en
dc.internal.availability Full text available en
dc.check.info Access to this article is restricted until 12 months after publication by request of the publisher. en
dc.check.date 2017-08-23
dc.description.version Published Version en
dc.contributor.funder ZonMw, the Netherlands
dc.description.status Peer reviewed en
dc.identifier.journaltitle Clinical Research in Cardiology en
dc.internal.IRISemailaddress patricia.kearney@ucc.ie
dc.internal.IRISemailaddress patricia.kearney@ucc.ie en


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© 2016, the Authors. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Except where otherwise noted, this item's license is described as © 2016, the Authors. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
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