title: Cholesterol, not just cardiovascular risk, is important in deciding who should receive statin treatment.
abstract: OBJECTIVE
  Guidelines for primary prevention of cardiovascular disease (CVD) with statins, including the most recent, fail to make the best use of the evidence from clinical trials by concentrating on absolute CVD risk as a statin indication and not also considering that a major determinant of therapeutic benefit is the magnitude of the low-density lipoprotein (LDL) (or non-HDL) cholesterol reduction achieved. This decrease is proportional to the pretreatment concentration. We set out to apply this knowledge to the calculation of the number needed to treat to prevent one event (NNT) and to assess critically how current guidelines performed at different degrees of CVD risk across a range of LDL (or non-HDL) cholesterol concentrations.
  
  
  RESULTS
  Number needed to treat to prevent one event revealed exclusion from the treatment of some people with higher cholesterol levels, who may benefit more than others needlessly exposed to statins with no realistic prospect of benefit. Furthermore, abandonment of cholesterol therapeutic goals disadvantaged people with higher levels.
  
  
  CONCLUSIONS
  These problems can be overcome by basing the decision to treat on the NNT calculated both from absolute CVD risk and also on the LDL (or non-HDL) cholesterol reduction achievable with statin treatment. This need not adds an additional layer of complexity for the clinician, because computer programmes already used to estimate CVD risk could be easily amended, thus permitting more effective deployment of statins in the population.
authors.affiliation: Cardiovascular Research Group, School of Biomedicine, University of Manchester, Core Technology Facility (3rd Floor), 46 Grafton Street, Manchester M13 9NT, UK Cardiovascular Trials Unit, University Department of Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors.forename: Handrean
authors.initials: H
authors.lastname: Soran
authors.affiliation: Cardiovascular Research Group, School of Biomedicine, University of Manchester, Core Technology Facility (3rd Floor), 46 Grafton Street, Manchester M13 9NT, UK Cardiovascular Trials Unit, University Department of Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Schofield
authors.affiliation: Cardiovascular Research Group, School of Biomedicine, University of Manchester, Core Technology Facility (3rd Floor), 46 Grafton Street, Manchester M13 9NT, UK pdurrington@manchester.ac.uk.
authors.forename: Paul N
authors.initials: PN
authors.lastname: Durrington
mesh_terms: D000924:Anticholesteremic Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D008076:Cholesterol, HDL / Q000378:metabolism*; D008078:Cholesterol, LDL / Q000378:metabolism*; D000066491:Clinical Decision-Making; D000069438:Ezetimibe / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D061366:Numbers Needed To Treat; D011322:Primary Prevention / Q000379:methods; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D000924:Anticholesteremic Agents; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000069438:Ezetimibe
keywords: Cardiovascular risk calculation; Number needed to treat; Primary prevention