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Research Article

Personalized Prediction of Lifetime Benefits with Statin Therapy for Asymptomatic Individuals: A Modeling Study

  • Bart S. Ferket,

    Affiliations: Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands, Department of Radiology, Erasmus MC, Rotterdam, the Netherlands

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  • Bob J. H. van Kempen,

    Affiliations: Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands, Department of Radiology, Erasmus MC, Rotterdam, the Netherlands

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  • Jan Heeringa,

    Affiliation: Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands

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  • Sandra Spronk,

    Affiliations: Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands, Department of Radiology, Erasmus MC, Rotterdam, the Netherlands

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  • Kirsten E. Fleischmann,

    Affiliation: Department of Medicine, University of California, San Francisco, California, United States of America

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  • Rogier L. G. Nijhuis,

    Affiliation: Department of Cardiology, Ziekenhuisgroep Twente, Hengelo, the Netherlands

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  • Albert Hofman,

    Affiliation: Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands

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  • Ewout W. Steyerberg,

    Affiliation: Department of Public Health, Erasmus MC, Rotterdam, the Netherlands

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  • M. G. Myriam Hunink mail

    m.hunink@erasmusmc.nl

    Affiliations: Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands, Department of Radiology, Erasmus MC, Rotterdam, the Netherlands, Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, United States of America

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  • Published: December 27, 2012
  • DOI: 10.1371/journal.pmed.1001361

Reader Comments (2)

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How long would one have to take statin .. and how about women

Posted by EddieVos on 30 Dec 2012 at 23:02 GMT

It is not clear from the article, and Table 3, how long one would have to take the statin to save 3 months of life, for example.

In my age category [65+] and BP [120], that would be 3 months for either gender. However, we know with certainty that there has not be a single study ever done that shows a mortality benefit in women, vs placebo. The same is true in men, for example ALL studies ever done with lova, atorva, ceriva, fluvastatin, and rosuvastatin if you ignore for the latter the cancer death reduction chance finding in JUPITER.

No competing interests declared.

RE: How long would one have to take statin .. and how about women

bartferket replied to EddieVos on 14 Jan 2013 at 15:59 GMT

Thank you for your response to our article. In our analysis, the duration of statin use is determined by the life expectancy with statin therapy assuming life-long treatment. We agree that this cannot be derived from the colour chart in Figure 3. We however provided a web-based calculator that can be used to estimate the life expectancy with (and without) statin therapy based on 13 variables. The calculator can be found on http://www.erasmusmc.nl/c....

In our analysis, the effect of statins on total mortality was solely effectuated indirectly through their effect on cardiovascular events. The resulting small benefit of statin therapy in decreasing all-cause mortality and prolonging life expectancy is supported by meta-analyses of RCTs, which predominantly included asymptomatic men and women [1-3]. One recently published report presented a meta-analysis of gender-specific outcomes. Also this report demonstrated a small, but statistically significant effect on all-cause mortality in the trials aimed at primary prevention: Odds Ratio 0.87, 95%CI: 0.78 to 0.97. The statin – gender interaction test was not significant, p for interaction = 0.51 [4], in agreement with Brugts et al [1].

In addition, the beneficial effect on life expectancy involves an improvement of the whole survival curve. Accumulation of small effects on short-term all-cause mortality will thus result in larger effects when short-term risks are extrapolated to longer time horizons.

The authors

References

1. Brugts JJ, Yetgin T, Hoeks SE, Gotto AM, Shepherd J, et al. (2009) The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: meta-analysis of randomised controlled trials. BMJ 338: b2376. doi: 10.1136/bmj.b2376.
2. Taylor F, Ward K, Moore TH, Burke M, Davey Smith G, et al. (2011) Statins for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev 1: CD004816.
3. Cholesterol Treatment Trialists' (CTT) Collaborators (2012) Mihaylova B, Emberson J, Blackwell L, Keech A, et al. (2012) The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet 380: 581–590 doi:10.1016/S0140-6736(12)60367-5.
4. Kostis WJ, Cheng JQ, Dobrzynski JM, Cabrera J, Kostis JB (2012) Meta-analysis of statin effects in women versus men. J Am Coll Cardiol 59: 572-582.

No competing interests declared.