Abstract
Background
Physicians need to inform asymptomatic individuals about personalized outcomes of statin therapy for primary prevention of cardiovascular disease (CVD). However, current prediction models focus on short-term outcomes and ignore the competing risk of death due to other causes. We aimed to predict the potential lifetime benefits with statin therapy, taking into account competing risks.
Methods and Findings
A microsimulation model based on 5-y follow-up data from the Rotterdam Study, a population-based cohort of individuals aged 55 y and older living in the Ommoord district of Rotterdam, the Netherlands, was used to estimate lifetime outcomes with and without statin therapy. The model was validated in-sample using 10-y follow-up data. We used baseline variables and model output to construct (1) a web-based calculator for gains in total and CVD-free life expectancy and (2) color charts for comparing these gains to the Systematic Coronary Risk Evaluation (SCORE) charts. In 2,428 participants (mean age 67.7 y, 35.5% men), statin therapy increased total life expectancy by 0.3 y (SD 0.2) and CVD-free life expectancy by 0.7 y (SD 0.4). Age, sex, smoking, blood pressure, hypertension, lipids, diabetes, glucose, body mass index, waist-to-hip ratio, and creatinine were included in the calculator. Gains in total and CVD-free life expectancy increased with blood pressure, unfavorable lipid levels, and body mass index after multivariable adjustment. Gains decreased considerably with advancing age, while SCORE 10-y CVD mortality risk increased with age. Twenty-five percent of participants with a low SCORE risk achieved equal or larger gains in CVD-free life expectancy than the median gain in participants with a high SCORE risk.
Conclusions
We developed tools to predict personalized increases in total and CVD-free life expectancy with statin therapy. The predicted gains we found are small. If the underlying model is validated in an independent cohort, the tools may be useful in discussing with patients their individual outcomes with statin therapy.
Full article http://www.plosmedicine.org/article
Graham
3 comments:
Hey Guys,
I went & had a look at the calculator.
It will not take HDL> 2.2 mmol/L (mine is 3).
When I claim to be diabetic & hypertensive & a smoker I have expectancy of 11 years (I claimed to be 70) with an extra "expectancy" of .2 year if I take statins.
When I removed these 3 "risk markers" ( 'cos that's I) - I have an expectancy of 15 years (all cause mortality) while an expectancy of 14.4 years (cardiac mortality). The extra expectancy fro taking statins is still 0.2 years.
Yer gorra laff, eh? Cos yer dead a long time.
Hi Leon your comment spurred me on so took the plunge and tried out the calculator, below are the results:
"Without statin therapy With statin therapy Absolute difference
Total life expectancy (years):
12.9
12.9
0.0
Coronary heart disease/stroke-free life expectancy (years):
12.4
12.6
0.2
Lifetime coronary heart disease/stroke incidence (%):
22%
17%
-5%
Lifetime coronary heart disease/stroke mortality (%):
7%
5%
-2%
Lifetime general cardiovascular disease mortality (%):
22%
21%
-1%"
If the calculator is anything to go by statins would have zero impact on my life expectancy.
Graham
Statins have pretty much zero effect on anyone’s life expectancy. But hey, a $30 billion a year earner for big pharma.
Eddie
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