Henock G. Yebyo, MSc; Hélène E. Aschmann, MSc; Milo A. Puhan, MD, PhD
Acknowledgment: The authors thank Oscar H. Franco (University of Bern, Bern, Switzerland, and Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands) for his valuable comments on an earlier version of the manuscript.
Grant Support: By grant 2015.0858 from the Swiss Government Excellence Scholarship Office, grant F-42320-71-01 from the North-South Cooperation at the University of Zurich, and the Béatrice Ederer-Weber Foundation.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-1279.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Proctor & Gamble, Pfizer, and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Not available. Statistical code: Available from Prof. Puhan (e-mail, firstname.lastname@example.org). Data set: Additional details can be made available (e-mail, email@example.com).
Corresponding Author: Milo A. Puhan, MD, PhD, University of Zurich, Epidemiology and Biostatistics and Prevention Institute, Hirschengraben 84, 8001 Zurich, Switzerland; e-mail, firstname.lastname@example.org.
Current author addresses and author contributions are available at Annals.org.
Current Author Addresses: Mr. Yebyo, Ms. Aschmann, and Prof. Puhan: University of Zurich, Epidemiology and Biostatistics and Prevention Institute, Hirschengraben 84, 8001 Zurich, Switzerland.
Author Contributions: Conception and design: H.G. Yebyo, M.A. Puhan.
Analysis and interpretation of the data: H.G. Yebyo, H.E. Aschmann, M.A. Puhan.
Drafting of the article: H.G. Yebyo, M.A. Puhan.
Critical revision of the article for important intellectual content: H.E. Aschmann, M.A. Puhan.
Final approval of the article: H.G. Yebyo, H.E. Aschmann, M.A. Puhan.
Provision of study materials or patients: M.A. Puhan.
Statistical expertise: H.G. Yebyo, H.E. Aschmann, M.A. Puhan.
Obtaining of funding: H.G. Yebyo, M.A. Puhan.
Administrative, technical, or logistic support: M.A. Puhan.
Collection and assembly of data: H.G. Yebyo, H.E. Aschmann, M.A. Puhan.
Many guidelines use expected risk for cardiovascular disease (CVD) during the next 10 years as a basis for recommendations on use of statins for primary prevention of CVD. However, how harms were considered and weighed against benefits is often unclear.
To identify the expected risk above which statins provide net benefit.
Quantitative benefit–harm balance modeling study.
Network meta-analysis of primary prevention trials, a preference survey, and selected observational studies.
Persons aged 40 to 75 years with no history of CVD.
Clinicians and guideline developers.
Low- or moderate-dose statin versus no statin.
The 10-year risk for CVD at which statins provide at least a 60% probability of net benefit, with baseline risk, frequencies of and preferences for statin benefits and harms, and competing risk for non-CVD death taken into account.
Younger men had net benefit at a lower 10-year risk for CVD than older men (14% for ages 40 to 44 years vs. 21% for ages 70 to 75 years). In women, the risk required for net benefit was higher (17% for ages 40 to 44 years vs. 22% for ages 70 to 75 years). Atorvastatin and rosuvastatin provided net benefit at lower 10-year risks than simvastatin and pravastatin.
Most alternative assumptions led to similar findings.
Age-specific data for some harms were not available.
Statins provide net benefits at higher 10-year risks for CVD than are reflected in most current guidelines. In addition, the level of risk at which net benefit occurs varies considerably by age, sex, and statin type.
Swiss Government Excellence Scholarship Office, Béatrice Ederer-Weber Foundation, and North-South Cooperation at the University of Zurich.
Yebyo HG, Aschmann HE, Puhan MA. Finding the Balance Between Benefits and Harms When Using Statins for Primary Prevention of Cardiovascular Disease: A Modeling Study. Ann Intern Med. 2019;170:1–10. [Epub ahead of print 4 December 2018]. doi: https://doi.org/10.7326/M18-1279
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Published: Ann Intern Med. 2019;170(1):1-10.
Published at www.annals.org on 4 December 2018
Cardiology, Coronary Risk Factors, Dyslipidemia, Prevention/Screening.
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