title: Personalized absolute benefit of statin treatment for primary or secondary prevention of vascular disease in individual elderly patients.
abstract: OBJECTIVE
  To estimate the absolute treatment effect of statin therapy on major adverse cardiovascular events (MACE; myocardial infarction, stroke and vascular death) for the individual patient aged ≥70 years.
  
  
  METHODS
  Prediction models for MACE were derived in patients aged ≥70 years with (n = 2550) and without (n = 3253) vascular disease from the "PROspective Study of Pravastatin in Elderly at Risk" (PROSPER) trial and validated in the "Secondary Manifestations of ARTerial disease" (SMART) cohort study (n = 1442) and the "Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm" (ASCOT-LLA) trial (n = 1893), respectively, using competing risk analysis. Prespecified predictors were various clinical characteristics including statin treatment. Individual absolute risk reductions (ARRs) for MACE in 5 and 10 years were estimated by subtracting on-treatment from off-treatment risk.
  
  
  RESULTS
  Individual ARRs were higher in elderly patients with vascular disease [5-year ARRs: median 5.1 %, interquartile range (IQR) 4.0-6.2 %, 10-year ARRs: median 7.8 %, IQR 6.8-8.6 %] than in patients without vascular disease (5-year ARRs: median 1.7 %, IQR 1.3-2.1 %, 10-year ARRs: 2.9 %, IQR 2.3-3.6 %). Ninety-eight percent of patients with vascular disease had a 5-year ARR ≥2.0 %, compared to 31 % of patients without vascular disease.
  
  
  CONCLUSIONS
  With a multivariable prediction model the absolute treatment effect of a statin on MACE for individual elderly patients with and without vascular disease can be quantified. Because of high ARRs, treating all patients is more beneficial than prediction-based treatment for secondary prevention of MACE. For primary prevention of MACE, the prediction model can be used to identify those patients who benefit meaningfully from statin therapy.
authors.affiliation: Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
authors.forename: Manon C
authors.initials: MC
authors.lastname: Stam-Slob
authors.affiliation: Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. f.l.j.visseren@umcutrecht.nl.|University Medical Center Utrecht, F02.224, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands. f.l.j.visseren@umcutrecht.nl.
authors.forename: Frank L J
authors.initials: FL
authors.lastname: Visseren
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Wouter Jukema
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: van der Graaf
authors.affiliation: Department of Vascular Medicine, ICCH, Imperial College London, White City, London, W12 0NN, UK.
authors.forename: Neil R
authors.initials: NR
authors.lastname: Poulter
authors.affiliation: Department of Vascular Medicine, ICCH, Imperial College London, White City, London, W12 0NN, UK.
authors.forename: Ajay
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Institute of Cardiovascular and Medical Sciences, Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA, UK.
authors.forename: Naveed
authors.initials: N
authors.lastname: Sattar
authors.affiliation: Institute of Cardiovascular and Medical Sciences, Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA, UK.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Macfarlane
authors.affiliation: Department of Epidemiology and Public Health, University College Cork, Western Rd, Cork, Ireland.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Kearney
authors.affiliation: Department of Gerontology and Geriatrics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
authors.forename: Anton J M
authors.initials: AJ
authors.lastname: de Craen
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.|Department of Gerontology and Geriatrics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
authors.forename: Stella
authors.initials: S
authors.lastname: Trompet
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D003661:Decision Support Techniques; D050171:Dyslipidemias / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D008055:Lipids / Q000097:blood*; D008297:Male; D015233:Models, Statistical; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D064887:Observational Studies as Topic; D011237:Predictive Value of Tests; D011322:Primary Prevention / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids
keywords: Absolute treatment effect; Elderly; Statin; Vascular disease