title: Maximal expected benefits from lowering cholesterol in primary prevention for a high-risk population.
abstract: The objective of this study was to estimate the maximal clinical benefit that could be reasonably expected from a cholesterol-lowering intervention.
  
  
  
  We used a hypothetical population at high risk of cardiovascular disease events from three risk assessment models including the Framingham risk function, the Score Canada and the Pooled Cohort Risk Assessment Equations. Our source population were all 55-year-old smoking men with diabetes, hypertension and low HDL. From this population, we identified two different subpopulations named "high" and "low", referring to their cholesterol levels which were set at 8.60 and 4.14 mmol/L respectively. Both subpopulations were identified for each risk assessment model in order to estimate the maximal impact of lowering cholesterol on cardiovascular disease events.
  
  
  
  Our extrapolations estimated that the maximal theoretical efficacy of a cholesterol-lowering intervention corresponds to a risk ratio ranging between 0.46 and 0.66 over a 10-year period. The number of events prevented during this period were between 21 and 29 per 100 patients which corresponds to a number needed to treat varying from 3.47 to 4.76.
  
  
  
  Our estimation showed the maximal clinical benefit that could be reasonably expected by an intervention that would lower total cholesterol in high-risk patients.
authors.affiliation: a Faculté de Médecine , Université de Montréal , Montreal , QC , Canada.|b Centre de Recherche du Centre Hospitalier de l'Université de Montréal , Montreal , QC , Canada.
authors.forename: Fiorella
authors.initials: F
authors.lastname: Fanton-Aita
authors.affiliation: a Faculté de Médecine , Université de Montréal , Montreal , QC , Canada.|b Centre de Recherche du Centre Hospitalier de l'Université de Montréal , Montreal , QC , Canada.|c Cardiology Division , Centre Hospitalier de l'Université de Montréal , Montreal , QC , Canada.
authors.forename: Alexis
authors.initials: A
authors.lastname: Matteau
authors.affiliation: a Faculté de Médecine , Université de Montréal , Montreal , QC , Canada.|b Centre de Recherche du Centre Hospitalier de l'Université de Montréal , Montreal , QC , Canada.
authors.forename: Ange Christelle
authors.initials: AC
authors.lastname: Iliza
authors.affiliation: a Faculté de Médecine , Université de Montréal , Montreal , QC , Canada.|b Centre de Recherche du Centre Hospitalier de l'Université de Montréal , Montreal , QC , Canada.
authors.forename: Dominic
authors.initials: D
authors.lastname: Mitchell
authors.affiliation: d McMaster University , Department of Clinical Epidemiology and Biostatistics , Hamilton , ON , Canada.|e Programs for Assessment of Technology in Health, St. Joseph's Healthcare Hamilton , Hamilton , ON , Canada.
authors.forename: Jason R
authors.initials: JR
authors.lastname: Guertin
authors.affiliation: f Beaulieu-Saucier Pharmacogenomics Centre, Montreal Heart Institute, Université de Montréal , Montreal , QC , Canada.
authors.forename: Anick
authors.initials: A
authors.lastname: Dubois
authors.affiliation: a Faculté de Médecine , Université de Montréal , Montreal , QC , Canada.|f Beaulieu-Saucier Pharmacogenomics Centre, Montreal Heart Institute, Université de Montréal , Montreal , QC , Canada.
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Dubé
authors.affiliation: a Faculté de Médecine , Université de Montréal , Montreal , QC , Canada.|f Beaulieu-Saucier Pharmacogenomics Centre, Montreal Heart Institute, Université de Montréal , Montreal , QC , Canada.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Tardif
authors.affiliation: a Faculté de Médecine , Université de Montréal , Montreal , QC , Canada.|b Centre de Recherche du Centre Hospitalier de l'Université de Montréal , Montreal , QC , Canada.
authors.forename: Jacques
authors.initials: J
authors.lastname: LeLorier
mesh_terms: D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011322:Primary Prevention / Q000379:methods / Q000706:statistics & numerical data; D018570:Risk Assessment
chemical_list: D000924:Anticholesteremic Agents
keywords: Cardiovascular disease; Cholesterol; High-risk; Maximal clinical benefit; Primary prevention; Risk assessment