TY - JOUR
T1 - Net benefit of statins for primary prevention of cardiovascular disease in people 75 years or older
T2 - a benefit–harm balance modeling study
AU - Yebyo, Henock G.
AU - Aschmann, Hélène E.
AU - Menges, Dominik
AU - Boyd, Cynthia M.
AU - Puhan, Milo A.
N1 - Publisher Copyright:
© The Author(s), 2019.
PY - 2019
Y1 - 2019
N2 - Background: We determined the risk thresholds above which statin use would be more likely to provide a net benefit for people over the age of 75 years without history of cardiovascular disease (CVD). Methods: An exponential model was used to estimate the differences in expected benefit and harms in people treated with statins over a 10-year horizon versus not treated. The analysis was repeated 100,000 times to consider the statistical uncertainty and produce a distribution of the benefit–harm balance index from which we determined the 10-year CVD risk threshold where benefits outweighed the harms. We considered treatment estimates from trials and observational studies, baseline risks, patient preferences, and competing risks of non-CVD death, and statistical uncertainty. Results: Based on average preferences, statins were more likely to provide a net benefit at a 10-year CVD risk of 24% and 25% for men aged 75–79 years and 80–84 years, respectively, and 21% for women in both age groups. However, these thresholds varied significantly depending on differences in individual patient preferences for the statin-related outcomes, with interquartile ranges of 21–33% and 23–36% for men aged 75–79 years and 80–84 years, respectively, as well as 20–32% and 21–32% for women aged 75–79 years and 80–84 years, respectively. Conclusions: Statins would more likely provide a net benefit for primary prevention in older people taking the average preferences if their CVD risk is well above 20%. However, the thresholds could be much higher or lower depending on preferences of individual patients, which suggests more emphasis should be placed on individual-based decision-making, instead of recommending statins for everyone based on a single or a small number of thresholds.
AB - Background: We determined the risk thresholds above which statin use would be more likely to provide a net benefit for people over the age of 75 years without history of cardiovascular disease (CVD). Methods: An exponential model was used to estimate the differences in expected benefit and harms in people treated with statins over a 10-year horizon versus not treated. The analysis was repeated 100,000 times to consider the statistical uncertainty and produce a distribution of the benefit–harm balance index from which we determined the 10-year CVD risk threshold where benefits outweighed the harms. We considered treatment estimates from trials and observational studies, baseline risks, patient preferences, and competing risks of non-CVD death, and statistical uncertainty. Results: Based on average preferences, statins were more likely to provide a net benefit at a 10-year CVD risk of 24% and 25% for men aged 75–79 years and 80–84 years, respectively, and 21% for women in both age groups. However, these thresholds varied significantly depending on differences in individual patient preferences for the statin-related outcomes, with interquartile ranges of 21–33% and 23–36% for men aged 75–79 years and 80–84 years, respectively, as well as 20–32% and 21–32% for women aged 75–79 years and 80–84 years, respectively. Conclusions: Statins would more likely provide a net benefit for primary prevention in older people taking the average preferences if their CVD risk is well above 20%. However, the thresholds could be much higher or lower depending on preferences of individual patients, which suggests more emphasis should be placed on individual-based decision-making, instead of recommending statins for everyone based on a single or a small number of thresholds.
KW - benefit–harm balance
KW - cardiovascular disease risk threshold
KW - lipid-lowering drugs
KW - primary CVD prevention
KW - statins
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U2 - 10.1177/2040622319877745
DO - 10.1177/2040622319877745
M3 - Article
C2 - 31598209
AN - SCOPUS:85073972099
SN - 2040-6223
VL - 10
JO - Therapeutic Advances in Chronic Disease
JF - Therapeutic Advances in Chronic Disease
ER -