Rodney A. Hayward, MD; Harlan M. Krumholz, MD; Donna M. Zulman, MD; Justin W. Timbie, PhD; Sandeep Vijan, MD, MSc
Acknowledgment: The authors thank Hwajung Choi, PhD, for her assistance with the statistical modeling.
Grant Support: In part by the Department of Veteran Affairs Health Services Research & Development Service's Quality Enhancement Research Initiative (QUERI DIB 98-001). The Measurement Core of the Michigan Diabetes Research & Training Center (National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health [P60 DK-20572]) provided consultative support.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M09-1850.
Reproducible Research Statement:Study protocol, statistical code, and data set: Available from Dr. Hayward (e-mail, email@example.com).
Corresponding Author: Rodney A. Hayward, MD, The Robert Wood Johnson Clinical Scholars Program, University of Michigan Medical School, 6312 Medical Science Building I, 1150 West Medical Center Drive, Ann Arbor, MI 48109; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Hayward and Zulman: The Robert Wood Johnson Clinical Scholars Program, University of Michigan Medical School, 6312 Medical Science Building I, 1150 West Medical Center Drive, Ann Arbor, MI 48109.
Dr. Krumholz: Yale University School of Medicine, 1 Church Street, Suite 200, New Haven, CT 06510.
Dr. Timbie: The RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202-5050.
Dr. Vijan: Veteran Affairs Health Services Research & Development Center of Excellence, VA Ann Arbor Healthcare System, PO Box 130170, Ann Arbor, MI 48113-0170.
Author Contributions: Conception and design: R.A. Hayward, S. Vijan.
Analysis and interpretation of the data: R.A. Hayward, H.M. Krumholz, D.M. Zulman, S. Vijan.
Drafting of the article: R.A. Hayward, D.M. Zulman, J.W. Timbie, S. Vijan.
Critical revision of the article for important intellectual content: R.A. Hayward, H.M. Krumholz, D.M. Zulman, J.W. Timbie, S. Vijan.
Final approval of the article: R.A. Hayward, H.M. Krumholz, D.M. Zulman, J.W. Timbie, S. Vijan.
Statistical expertise: R.A. Hayward, J.W. Timbie, S. Vijan.
Obtaining of funding: R.A. Hayward.
Administrative, technical, or logistic support: R.A. Hayward.
Collection and assembly of data: R.A. Hayward, J.W. Timbie.
Hayward RA, Krumholz HM, Zulman DM, Timbie JW, Vijan S. Optimizing Statin Treatment for Primary Prevention of Coronary Artery Disease. Ann Intern Med. 2010;152:69-77. doi: 10.7326/0003-4819-152-2-201001190-00004
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Published: Ann Intern Med. 2010;152(2):69-77.
Although treating to lipid targets (â€œtreat to targetâ€) is widely recommended for coronary artery disease (CAD) prevention, some have advocated administering fixed doses of statins based on a person's estimated net benefit (â€œtailored treatmentâ€).
To examine how a tailored treatment approach to statin therapy compares with a treat-to-target approach.
Simulated model of population-level effects of treat-to-target and tailored treatment approaches to statin therapy.
Statin trials from 1994 to 2009 and nationally representative CAD risk factor data.
U.S. persons aged 30 to 75 years with no history of myocardial infarction.
Lifetime effects of 5 years of treatment.
Societal and patient.
Tailored treatment based on a person's 5-year CAD risk (simvastatin, 40 mg, for 5% to 15% CAD risk and atorvastatin, 40 mg, for CAD risk >15%) versus treat-to-target approaches that escalate statin dose per National Cholesterol Education Program [NCEP] III guidelines (including an intensive approach that advances treatment whenever intensification is optional by NCEP III criteria).
Quality-adjusted life-years (QALYs).
Compared with the standard NCEP III approach, the intensive NCEP III approach treated 15 million more persons and saved 570Â 000 more QALYs over 5 years. The tailored strategy treated a similar number of persons, as did the intensive NCEP III approach, but saved 500Â 000 more QALYs and treated fewer persons with high-dose statins.
No circumstances were found in which a treat-to-target approach was preferable to tailored treatment.
Model assumptions were based on available clinical data, which included few persons 75 years or older.
A tailored treatment strategy prevents more CAD events while treating fewer persons with high-dose statins than low-density lipoprotein cholesterolâ€“based target approaches. Results were robust, even with assumptions favoring a treat-to-target approach.
Department of Veteran Affairs Health Services Research & Development Service's Quality Enhancement Research Initiative.
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Cardiology, Dyslipidemia, Coronary Risk Factors, Prevention/Screening.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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