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@article{Stam-Slob:2016:10.1007/s00392-016-1023-8,
author = {Stam-Slob, MC and Visseren, FL and Wouter, Jukema J and van, der Graaf Y and Poulter, NR and Gupta, A and Sattar, N and Macfarlane, PW and Kearney, PM and de, Craen AJ and Trompet, S},
doi = {10.1007/s00392-016-1023-8},
journal = {Clinical Research in Cardiology},
pages = {58--68},
title = {Personalized absolute benefit of statin treatment for primary or secondary prevention of vascular disease in individual elderly patients},
url = {http://dx.doi.org/10.1007/s00392-016-1023-8},
volume = {106},
year = {2016}
}

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TY  - JOUR
AB  - 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.
AU  - Stam-Slob,MC
AU  - Visseren,FL
AU  - Wouter,Jukema J
AU  - van,der Graaf Y
AU  - Poulter,NR
AU  - Gupta,A
AU  - Sattar,N
AU  - Macfarlane,PW
AU  - Kearney,PM
AU  - de,Craen AJ
AU  - Trompet,S
DO  - 10.1007/s00392-016-1023-8
EP  - 68
PY  - 2016///
SN  - 1861-0692
SP  - 58
TI  - Personalized absolute benefit of statin treatment for primary or secondary prevention of vascular disease in individual elderly patients
T2  - Clinical Research in Cardiology
UR  - http://dx.doi.org/10.1007/s00392-016-1023-8
UR  - http://hdl.handle.net/10044/1/39617
VL  - 106
ER  -

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Dr Ajay K Gupta

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