Michelle C. Odden, PhD; Mark J. Pletcher, MD, MPH; Pamela G. Coxson, PhD; Divya Thekkethala, BS; David Guzman, MS; David Heller, MD; Lee Goldman, MD, MPH; Kirsten Bibbins-Domingo, MD, PhD
Disclaimer: Dr. Bibbins-Domingo is currently co-vice chair of the U.S. Preventive Services Task Force (USPSTF). This work does not necessarily represent the views and policies of the USPSTF. This manuscript was prepared using Framingham Cohort and Framingham Offspring Research Materials obtained from the NHLBI Biologic Specimen and Data Repository Information Coordinating Center and does not necessarily reflect the opinions or views of the Framingham Cohort, Framingham Offspring, or the NHLBI.
Grant Support: By the American Heart Association Western States Affiliate (11CRP7210088), the National Institute on Aging (K01AG039387), and the National Institute for Diabetes and Digestive and Kidney Diseases (K24DK103992).
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-1430.
Reproducible Research Statement:Study protocol: Not available. Statistical code: Persons interested in joining the Intellectual Property Commons that is committed to improving the model and using it for scientific purposes should contact Dr. Goldman (e-mail, email@example.com). Data set: All data are publicly available, and sources are listed in the references and the Appendix.
Requests for Single Reprints: Michelle C. Odden, PhD, Oregon State University, 141B Milam Hall, Corvallis, OR 97331.
Current Author Addresses: Dr. Odden and Ms. Thekkethala: Oregon State University, 141B Milam Hall, Corvallis, OR 97331.
Dr. Pletcher: Department of Epidemiology and Biostatistics, University of California, San Francisco, UCSF Box 0560, 185 Berry Street, Lobby 5, Suite 5700, San Francisco, CA 94107-1762.
Drs. Coxson, Heller, and Bibbins-Domingo and Mr. Guzman: Department of Medicine, University of California, San Francisco, 1001 Potrero Avenue, Building 10, W13, UCSF-SFGH Box 1364, San Francisco, CA 94110.
Dr. Goldman: Columbia University Medical Center, College of Physicians and Surgeons, 630 West 168th Street, 2nd Floor, Room 401, New York, NY 10032.
Author Contributions: Conception and design: M.C. Odden, K. Bibbins-Domingo.
Analysis and interpretation of the data: M.C. Odden, M.J. Pletcher, P.G. Coxson, D. Thekkethala, D. Guzman, D. Heller, L. Goldman, K. Bibbins-Domingo.
Drafting of the article: M.C. Odden, K. Bibbins-Domingo.
Critical revision of the article for important intellectual content: M.C. Odden, M.J. Pletcher, P.G. Coxson, D. Thekkethala, D. Heller, L. Goldman, K. Bibbins-Domingo.
Final approval of the article: M.C. Odden, M.J. Pletcher, D. Heller, L. Goldman, K. Bibbins-Domingo.
Provision of study materials or patients: L. Goldman, K. Bibbins-Domingo.
Statistical expertise: M.C. Odden, P.G. Coxson, K. Bibbins-Domingo.
Obtaining of funding: M.C. Odden, K. Bibbins-Domingo.
Administrative, technical, or logistic support: M.C. Odden, D. Thekkethala, L. Goldman, K. Bibbins-Domingo.
Collection and assembly of data: M.C. Odden, D. Thekkethala, D. Guzman, K. Bibbins-Domingo.
Evidence to guide primary prevention in adults aged 75 years or older is limited.
To project the population impact and cost-effectiveness of statin therapy in adults aged 75 years or older.
Forecasting study using the Cardiovascular Disease Policy Model, a Markov model.
Trial, cohort, and nationally representative data sources.
U.S. adults aged 75 to 94 years.
Health care system.
Statins for primary prevention based on low-density lipoprotein cholesterol threshold of 4.91 mmol/L (190 mg/dL), 4.14 mmol/L (160 mg/dL), or 3.36 mmol/L (130 mg/dL); presence of diabetes; or 10-year risk score of at least 7.5%.
Myocardial infarction (MI), coronary heart disease (CHD) death, disability-adjusted life-years, and costs.
All adults aged 75 years or older in the National Health and Nutrition Examination Survey have a 10-year risk score greater than 7.5%. If statins had no effect on functional limitation or cognitive impairment, all primary prevention strategies would prevent MIs and CHD deaths and be cost-effective. Treatment of all adults aged 75 to 94 years would result in 8 million additional users and prevent 105 000 (4.3%) incident MIs and 68 000 (2.3%) CHD deaths at an incremental cost per disability-adjusted life-year of $25 200.
An increased relative risk for functional limitation or mild cognitive impairment of 1.10 to 1.29 could offset the cardiovascular benefits.
Limited trial evidence targeting primary prevention in adults aged 75 years or older.
At effectiveness similar to that in trials, statins are projected to be cost-effective for primary prevention; however, even a small increase in geriatric-specific adverse effects could offset the cardiovascular benefit. Improved data on the potential benefits and harms of statins are needed to inform decision making.
American Heart Association Western States Affiliate, National Institute on Aging, and the National Institute for Diabetes on Digestive and Kidney Diseases.
Michelle C. Odden, Mark J. Pletcher, Pamela G. Coxson, Divya Thekkethala, David Guzman, David Heller, et al. Cost-Effectiveness and Population Impact of Statins for Primary Prevention in Adults Aged 75 Years or Older in the United States. Ann Intern Med. 2015;162:533–541. doi: 10.7326/M14-1430
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Published: Ann Intern Med. 2015;162(8):533-541.
Cardiology, Coronary Risk Factors, Dyslipidemia, Prevention/Screening.
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