High-Dose Statin Therapy in Patients With Stable Coronary Artery Disease

Dorresteijn, Johannes A N; Boekholdt, S. Matthijs; Graaf, Yolanda van der; Kastelein, John J.P.; LaRosa, John C.; Pedersen, Terje R.; DeMicco, David A.; Ridker, Paul M.; Cook, Nancy R.; Visseren, Frank L.J.

doi:10.1161/circulationaha.112.000712

Cited by 37 publications

(23 citation statements)

References 37 publications

(48 reference statements)

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“…They increased with age according to the TNT/IDEAL prediction model (Box 1). 7 For selective benefit‐based treatment, those with an ARR above the intensive treatment threshold had higher event probabilities than those with a predicted ARR beneath this threshold. Box 2 shows a detailed example of estimation of event risk and intensive LLT treatment effect for benefit‐based treatment.…”

Section: Methodsmentioning

confidence: 98%

“…The derivation of the prediction model in the TNT trial and validation in the IDEAL trial is explained in detail previously 7. These studies were approved by the local or regional institutional review committee at each participating center, and all subjects gave informed consent.…”

Section: Methodsmentioning

confidence: 99%

“…Individual patients' 5‐year risk and ARR with intensive LLT with statins for the combined outcome of vascular events is estimated with this model (Box 1). 7 Those at highest risk for vascular events will also have the highest ARR with intensive LLT. The prediction model can be applied in clinical practice by choosing a treatment threshold, which is the minimal predicted ARR from which a physician is willing to treat a patient intensively.…”

Section: Methodsmentioning

confidence: 99%

“…Patients had a mean age of 61 years, and 81% were male 7. The medical history contained an MI in 78% of patients, a PCI in 40%, a CABG in 34%, and cerebrovascular disease in 6% of patients.…”

Section: Methodsmentioning

confidence: 99%

“…Previously, we derived a prediction model in the Treating to New Targets (TNT) trial population that estimates 5‐year absolute treatment effect of intensive versus standard LLT with statins on recurrent vascular events for an individual patient, which was validated in the Incremental Decrease in End point through Aggressive Lipid‐lowering (IDEAL) trial population 7, 8, 9. With this model, we are able to estimate the individual 5‐year absolute risk reduction (ARR) for vascular events based on simple patient characteristics 7, 10. Considering the intention for lifelong treatment and potential adverse effects, it may be worthwhile to target intensification of LTT to those patients who benefit most.…”

Section: Introductionmentioning

confidence: 99%

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Cost‐Effectiveness of Intensifying Lipid‐Lowering Therapy With Statins Based on Individual Absolute Benefit in Coronary Artery Disease Patients

Stam‐Slob

Graaf

Greving

et al. 2017

JAHA

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BackgroundA validated prediction model estimates the absolute benefit of intensive versus standard lipid‐lowering therapy (LLT) with statins on next major cardiovascular events for individual patients with coronary artery disease. We aimed to assess whether targeting intensive LLT therapy to coronary artery disease patients with the highest predicted absolute benefit is cost‐effective compared to treating all with standard or all with intensive LLT.Methods and ResultsA lifetime Markov model was constructed for coronary artery disease patients (n=10 000) with mean age 61 years. Number of major cardiovascular events, (non) vascular death, costs, and quality‐adjusted life years (QALYs) were estimated for the following strategies: (1) standard LLT for all (reference strategy); (2) intensive LLT for those with 5‐year absolute major cardiovascular events risk reduction (ARR) ≥3%, ≥2.3%, or ≥1.5% (corresponding to ≥20%, ≥15%, or ≥10% 5‐year major cardiovascular events risk); and (3) intensive LLT for all. With intensive LLT for those with ≥3% 5‐year ARR (13% of patients), 380 QALYs were gained for €2423/QALY. Using a threshold of ≥2.3% ARR (26% of patients), 630 QALYs were gained for €5653/QALY. Using a threshold of ≥1.5% ARR (56% of patients), 1020 QALYs were gained for €10 960/QALY. By treating all intensively, 1410 QALYs were gained (0.14 QALY per patient) for €17 223/QALY. With benefit‐based treatment, 0.16 to 0.17 QALY was gained per treated patient.ConclusionsIntensive LLT with statins for all coronary artery disease patients results in the highest overall QALY gain against acceptable costs. However, the number of QALYs gained with intensive LLT by statins in individual patients can be increased with selective benefit‐based treatment.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00327691 and NCT00159835

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Section: Methodsmentioning

confidence: 98%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Cost‐Effectiveness of Intensifying Lipid‐Lowering Therapy With Statins Based on Individual Absolute Benefit in Coronary Artery Disease Patients

Stam‐Slob

Graaf

Greving

et al. 2017

JAHA

Self Cite

View full text Add to dashboard Cite

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Translating Comparative Effectiveness Research Evidence to Real-World Decision Making: Some Practical Considerations

Willke¹

2017

Decision Making in a World of Comparative Effectiveness Research

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Rosuvastatin for Reduction of Myocardial Damage during Coronary Angioplasty - the Remedy Trial

Briguori

Madonna

Zimarino

et al. 2016

Cardiovasc Drugs Ther

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The REMEDY study will enroll a total of 1080 patients submitted to elective PCI. Eligible patients will be randomized into 4 groups: 1) placebo; 2) atorvastatin (80 mg + 40 mg before PCI); 3) rosuvastatin (40 mg twice before PCI); and 4) rosuvastatin (5 mg) and ezetimibe (10 mg) twice before PCI. Peri-procedural MI is defined as an elevation of markers of cardiac injury (either CK-MB or troponin I or T) values >5x the upper reference limit estimated at the 99th percentile of the normal distribution, or a rise >20 % in case of baseline values already elevated. EPCs will be assessed before, at 24 h and - in a subset of diabetic patients - at 3 months after PCI (EPC-substudies). The primary endpoint of the main REMEDY study is the rate of peri-procedural MI in each of the 4 treatment arms. Secondary endpoints are the combined occurrence of 1-month major adverse events (MACE, including death, MI, or the need for unplanned revascularization); and any post-procedural increase in serum creatinine. Endpoints of the EPC-substudies are the impact of tested regimens on 1) early (24-h) and 3-month EPC levels and functional activity; 2) stent strut re-endothelialization and neointimal hyperplasia; 3) 1-year MACE. REMEDY will add important information on the cardioprotective effects of statins after PCI.

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High-Dose Statin Therapy in Patients With Stable Coronary Artery Disease

Cited by 37 publications

References 37 publications

Cost‐Effectiveness of Intensifying Lipid‐Lowering Therapy With Statins Based on Individual Absolute Benefit in Coronary Artery Disease Patients

Cost‐Effectiveness of Intensifying Lipid‐Lowering Therapy With Statins Based on Individual Absolute Benefit in Coronary Artery Disease Patients

Translating Comparative Effectiveness Research Evidence to Real-World Decision Making: Some Practical Considerations

Rosuvastatin for Reduction of Myocardial Damage during Coronary Angioplasty - the Remedy Trial

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