title: Distribution of lifespan gain from primary prevention intervention.
abstract: When advising patients about possible initiation of primary prevention treatment, clinicians currently do not have information on expected impact on lifespan, nor how much this increment differs between individuals.
  
  
  
  First, UK cardiovascular and non-cardiovascular mortality data were used to calculate the mean lifespan gain from an intervention (such as a statin) that reduces cardiovascular mortality by 30%. Second, a new method was developed to calculate the probability distribution of lifespan gain. Third, we performed a survey in three UK cities on 11 days between May-June 2014 involving 396 participants (mean age 40 years, 55% male) to assess how individuals evaluate potential benefit from primary prevention therapies.
  
  
  
  Among numerous identical patients, the lifespan gain, from an intervention that reduces cardiovascular mortality by 30%, is concentrated within an unpredictable minority. For example, men aged 50 years with national average cardiovascular risk have mean lifespan gain of 7 months. However, 93% of these identical individuals gain no lifespan, while the remaining 7% gain a mean of 99 months. Many survey respondents preferred a chance of large lifespan gain to the equivalent life expectancy gain given as certainty. Indeed, 33% preferred a 2% probability of 10 years to fivefold more gain, expressed as certainty of 1 year.
  
  
  
  People who gain lifespan from preventative therapy gain far more than the average for their risk stratum, even if perfectly defined. This may be important in patient decision-making. Looking beyond mortality reduction alone from preventative therapy, the benefits are likely to be even larger.
authors.affiliation: International Centre for Circulatory Health, National Heart and Lung Institute , London , UK.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Finegold
authors.affiliation: International Centre for Circulatory Health, National Heart and Lung Institute , London , UK.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Shun-Shin
authors.affiliation: International Centre for Circulatory Health, National Heart and Lung Institute , London , UK.
authors.forename: Graham D
authors.initials: GD
authors.lastname: Cole
authors.affiliation: International Centre for Circulatory Health, National Heart and Lung Institute , London , UK.
authors.forename: Saman
authors.initials: S
authors.lastname: Zaman
authors.affiliation: Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle , UK.
authors.forename: Annette
authors.initials: A
authors.lastname: Maznyczka
authors.affiliation: International Centre for Circulatory Health, National Heart and Lung Institute , London , UK.
authors.forename: Sameer
authors.initials: S
authors.lastname: Zaman
authors.affiliation: International Centre for Circulatory Health, National Heart and Lung Institute , London , UK.
authors.forename: Rasha
authors.initials: R
authors.lastname: Al-Lamee
authors.affiliation: Department of Medicine , Center for Behavioral Cardiovascular Health , New York, New York , USA.
authors.forename: Siqin
authors.initials: S
authors.lastname: Ye
authors.affiliation: International Centre for Circulatory Health, National Heart and Lung Institute , London , UK.
authors.forename: Darrel P
authors.initials: DP
authors.lastname: Francis
keywords: LIPIDS