Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Jan;106(1):58-68.
doi: 10.1007/s00392-016-1023-8. Epub 2016 Aug 23.

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

Manon C Stam-Slob  1 , Frank L J Visseren  2   3 , J Wouter Jukema  4 , Yolanda van der Graaf  5 , Neil R Poulter  6 , Ajay Gupta  6 , Naveed Sattar  7 , Peter W Macfarlane  7 , Patricia M Kearney  8 , Anton J M de Craen  9 , Stella Trompet  4   9
Affiliations

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

Manon C Stam-Slob et al. Clin Res Cardiol. 2017 Jan.

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.

Keywords: Absolute treatment effect; Elderly; Statin; Vascular disease.

PubMed Disclaimer

Conflict of interest statement

JWJ/his department has received research grants from and/or was speaker (with or without lecture fees) on a.o. (CME accredited) meetings sponsored by Amgen, Astellas, Anthera, Astra-Zeneca, Bayer, Biotronik, Boston Scientific, Daiichi Sankyo, Lilly, Genzyme, Medtronic, Merck-Schering-Plough, Pfizer, Orbus Neich, Novartis, Roche, Servier, Sanofi Aventis, The Medicine Company, the Netherlands Heart Foundation, CardioVascular Research the Netherlands (CVON), the Interuniversity Cardiology Institute of the Netherlands and the European Community Framework KP7 Programme. AG received a travel grant from Pfizer inc. NS reports personal fees from Amgen, personal fees from Astrazeneca, personal fees from Merck, during the conduct of the study. MCS-S, FLJV, YvdG, NRP, PWM, PKM and ST have nothing to disclose. Ethical standards All studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to their inclusion in the study.

Figures

Fig. 1
Fig. 1
Calibration plots of predicted versus observed MACE risk in elderly patients
Fig. 2
Fig. 2
Distribution of 5-year absolute risk for MACE and the absolute risk reduction with statin therapy in elderly patients
Fig. 3
Fig. 3
Distribution of 10-year absolute risk for MACE and the absolute risk reduction with statin therapy in elderly patients
See this image and copyright information in PMC

References

    1. Prince MJ, Wu F, Guo Y, Gutierrez Robledo LM, O’Donnell M, Sullivan R, Yusuf S. The burden of disease in older people and implications for health policy and practice. Lancet. 2015;385:549–562. doi: 10.1016/S0140-6736(14)61347-7. - DOI - PubMed
    1. Jaguszewski M, Ghadri JR, Diekmann J, Bataiosu RD, Hellermann JP, Sarcon A, Siddique A, Baumann L, Stahli BE, Luscher TF, Maier W, Templin C. Acute coronary syndromes in octogenarians referred for invasive evaluation: treatment profile and outcomes. Clin Res Cardiol. 2015;104:51–58. doi: 10.1007/s00392-014-0756-5. - DOI - PubMed
    1. Hollander M, Koudstaal PJ, Bots ML, Grobbee DE, Hofman A, Breteler MM. Incidence, risk, and case fatality of first ever stroke in the elderly population. The Rotterdam study. J Neurol Neurosurg Psychiatry. 2003;74:317–321. doi: 10.1136/jnnp.74.3.317. - DOI - PMC - PubMed
    1. Shepherd J, Blauw GJ, Murphy MB, Bollen EL, Buckley BM, Cobbe SM, Ford I, Gaw A, Hyland M, Jukema JW, Kamper AM, Macfarlane PW, Meinders AE, Norrie J, Packard CJ, Perry IJ, Stott DJ, Sweeney BJ, Twomey C, Westendorp RG. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet. 2002;360:1623–1630. doi: 10.1016/S0140-6736(02)11600-X. - DOI - PubMed
    1. Kutner JS, Blatchford PJ, Taylor DH, Jr, Ritchie CS, Bull JH, Fairclough DL, Hanson LC, LeBlanc TW, Samsa GP, Wolf S, Aziz NM, Currow DC, Ferrell B, Wagner-Johnston N, Zafar SY, Cleary JF, Dev S, Goode PS, Kamal AH, Kassner C, Kvale EA, McCallum JG, Ogunseitan AB, Pantilat SZ, Portenoy RK, Prince-Paul M, Sloan JA, Swetz KM, Von Gunten CF, Abernethy AP. Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial. JAMA Intern Med. 2015;175:691–700. doi: 10.1001/jamainternmed.2015.0289. - DOI - PMC - PubMed

Publication types

MeSH terms