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

dc.check.date2017-08-23
dc.check.infoAccess to this article is restricted until 12 months after publication by request of the publisher.en
dc.contributor.authorStam-Slob, Manon C.
dc.contributor.authorVisseren, Frank L. J.
dc.contributor.authorJukema, J. Wouter
dc.contributor.authorvan der Graaf, Yolanda
dc.contributor.authorPoulter, Neil R.
dc.contributor.authorGupta, Ajay
dc.contributor.authorSattar, Naveed
dc.contributor.authorMacfarlane, Peter W.
dc.contributor.authorKearney, Patricia M.
dc.contributor.authorde Craen, Anton J. M.
dc.contributor.authorTrompet, Stella
dc.contributor.funderZonMw, the Netherlands
dc.date.accessioned2016-09-23T08:13:53Z
dc.date.available2016-09-23T08:13:53Z
dc.date.issued2016-08-23
dc.description.abstractObjective: 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.sponsorshipZonMw, the Netherlands (Grant No. 836011027)en
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationStam-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/s00392-016-1023-8en
dc.identifier.doi10.1007/s00392-016-1023-8
dc.identifier.endpage11en
dc.identifier.issn1861-0684
dc.identifier.journaltitleClinical Research in Cardiologyen
dc.identifier.startpage1en
dc.identifier.urihttps://hdl.handle.net/10468/3112
dc.language.isoenen
dc.publisherSpringer International Publishingen
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.urihttp://creativecommons.org/licenses/by/4.0/en
dc.subjectElderlyen
dc.subjectStatinen
dc.subjectAbsolute treatment effecten
dc.subjectVascular diseaseen
dc.titlePersonalized absolute benefit of statin treatment for primary or secondary prevention of vascular disease in individual elderly patientsen
dc.typeArticle (peer-reviewed)en
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