Statins for Prevention of Cardiovascular Disease in Adults

Chou, Roger; Dana, Tracy; Blazina, Ian; Daeges, Monica; Jeanne, Thomas L.

doi:10.1001/jama.2015.15629

Cited by 486 publications

(217 citation statements)

References 71 publications

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“…30 Statins have been recommended in adults with a cardiovascular disease risk of 10% but without cardiovascular disease 31 based on absolute risk reductions of 0.4% and 1.4% for all-cause and composite cardiovascular mortality, respectively. 32 …”

Section: Discussionmentioning

confidence: 99%

Effect of Therapeutic Hypothermia Initiated After 6 Hours of Age on Death or Disability Among Newborns With Hypoxic-Ischemic Encephalopathy

Laptook

Shankaran

Tyson

et al. 2017

JAMA

228

120

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IMPORTANCE Hypothermia initiated at less than 6 hours after birth reduces death or disability for infants with hypoxic-ischemic encephalopathy at 36 weeks’ or later gestation. To our knowledge, hypothermia trials have not been performed in infants presenting after 6 hours. OBJECTIVE To estimate the probability that hypothermia initiated at 6 to 24 hours after birth reduces the risk of death or disability at 18 months among infants with hypoxic-ischemic encephalopathy. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial was conducted between April 2008 and June 2016 among infants at 36 weeks’ or later gestation with moderate or severe hypoxic-ischemic encephalopathy enrolled at 6 to 24 hours after birth. Twenty-one US Neonatal Research Network centers participated. Bayesian analyses were prespecified given the anticipated limited sample size. INTERVENTIONS Targeted esophageal temperature was used in 168 infants. Eighty-three hypothermic infants were maintained at 33.5°C (acceptable range, 33°C–34°C) for 96 hours and then rewarmed. Eighty-five noncooled infants were maintained at 37.0°C (acceptable range, 36.5°C–37.3°C). MAIN OUTCOMES AND MEASURES The composite of death or disability (moderate or severe) at 18 to 22 months adjusted for level of encephalopathy and age at randomization. RESULTS Hypothermic and noncooled infants were term (mean [SD], 39 [2] and 39 [1] weeks’ gestation, respectively), and 47 of 83 (57%) and 55 of 85 (65%) were male, respectively. Both groups were acidemic at birth, predominantly transferred to the treating center with moderate encephalopathy, and were randomized at a mean (SD) of 16 (5) and 15 (5) hours for hypothermic and noncooled groups, respectively. The primary outcome occurred in 19 of 78 hypothermic infants (24.4%) and 22 of 79 noncooled infants (27.9%) (absolute difference, 3.5%; 95% CI, −1% to 17%). Bayesian analysis using a neutral prior indicated a 76% posterior probability of reduced death or disability with hypothermia relative to the noncooled group (adjusted posterior risk ratio, 0.86; 95% credible interval, 0.58–1.29). The probability that death or disability in cooled infants was at least 1%, 2%, or 3% less than noncooled infants was 71%, 64%, and 56%, respectively. CONCLUSIONS AND RELEVANCE Among term infants with hypoxic-ischemic encephalopathy, hypothermia initiated at 6 to 24 hours after birth compared with noncooling resulted in a 76% probability of any reduction in death or disability, and a 64% probability of at least 2% less death or disability at 18 to 22 months. Hypothermia initiated at 6 to 24 hours after birth may have benefit but there is uncertainty in its effectiveness. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00614744

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Section: Discussionmentioning

confidence: 99%

Effect of Therapeutic Hypothermia Initiated After 6 Hours of Age on Death or Disability Among Newborns With Hypoxic-Ischemic Encephalopathy

Laptook

Shankaran

Tyson

et al. 2017

JAMA

228

120

View full text Add to dashboard Cite

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“…In three recent meta-analyses of observational studies of prostate 1 , breast 2 and colorectal cancer 3 , the cancer survival was 18 to 44 percent greater in statin users compared with non-users. The magnitude of this inverse association is stronger than the beneficial effect of statins on all-cause mortality (14 percent) in randomized trials of individuals without cancer, 4 which has led to calls for further research 5 .…”

Section: Introductionmentioning

confidence: 99%

Examining Bias in Studies of Statin Treatment and Survival in Patients With Cancer

et al. 2018

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Importance Cancer patients who use statins appear to have a substantially better survival than non-users in observational studies. However, this inverse association between statin use and mortality in cancer patients may be due to selection bias and immortal time bias. Objective We used observational data to emulate a randomized trial of statin initiation that is free of selection bias and immortal time bias. Design We used data on 17,372 cancer patients from the SEER-Medicare 2007-2009 database with complete follow-up until 2011. Individuals were duplicated, with each replicate assigned to either the strategy “statin initiation within 6 months of diagnosis” or “no statin initiation”. Replicates were censored when they stopped following their assigned strategy, and the potential selection bias was adjusted for via inverse-probability weighting. Hazard ratios (HR), cumulative incidences, and risk differences were calculated for all-cause mortality and cancer-specific mortality. We then compared our estimates with those obtained using the same analytic approaches as in previous observational studies. Setting The SEER-Medicare data is a linkage between 17 American cancer registries and claims files from Medicare and Medicaid in 12 states. Participants We included individuals with a new diagnosis of colorectal, breast, prostate, and bladder cancer who had not been prescribed statins for at least 6 months before cancer. Exposure Statin initiation within 6 months from cancer diagnosis. Main outcome measure Cancer-specific and all-cause mortality. Results The adjusted HR (95% CI) comparing statin initiation vs. no initiation was 1.00 (0.88-1.15) for cancer-specific mortality and 1.07 (0.93-1.21) for overall mortality. Cumulative incidence curves for each group were almost overlapping. On the contrary, the methods used by prior studies resulted in a strong inverse association between statin use and mortality. Conclusion and relevance After using methods that are not susceptible to selection bias from prevalent users and to immortal time bias, initiation of statins within 6 months of cancer diagnosis did not appear to improve 3-year cancer-specific or overall survival.

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“…The USPSTF performed a systematic review and produced an evidence report that was used to determine the 10% risk threshold 11. The authors of the USPSTF guidelines did cite data raising concern that the PCE may overestimate risk in modern populations as one of the rationales for choosing the more conservative 10% risk threshold 12, 13.…”

Section: Discussionmentioning

confidence: 99%

Statin Eligibility, Coronary Artery Calcium, and Subsequent Cardiovascular Events According to the 2016 United States Preventive Services Task Force (USPSTF) Statin Guidelines: MESA (Multi‐Ethnic Study of Atherosclerosis)

Miedema

Dardari

Kianoush

et al. 2018

JAHA

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BackgroundThe potential impact of the 2016 United States Preventive Services Task Force (USPSTF) guidelines on statins for primary prevention of atherosclerotic cardiovascular disease (ASCVD) warrants further analysis.Methods and ResultsWe studied participants from MESA (Multi‐Ethnic Study of Atherosclerosis) aged 40 to 75 years and not on statins. We compared statin eligibility at baseline (2000–2002) and over follow‐up between USPSTF and the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines. Coronary artery calcium (CAC) was measured at baseline. Absolute ASCVD event rates were calculated according to eligibility categories for each guideline. Among 4962 MESA participants (aged 59.3±8.8 years, 47.2% female), compared with ACC/AHA guidelines, baseline statin eligibility by USPSTF was significantly lower (34.4% versus 49.1%) and increased less over time (39.1% versus 59.1%) at examination 5 [years 2010–2012]). Compared with ACC/AHA, participants eligible by USPSTF were less likely to have zero CAC at baseline (36.6% versus 41.2%) and had higher rates of hard ASCVD events per 1000 person‐years (11.6 [95% confidence interval, 10.2–13.3] versus 10.0 [8.9–11.3]). The hard ASCVD event rate in those eligible by ACC/AHA but not USPSTF was 6.5 (4.9–8.5) events per 1000 person‐years, with the rate varying significantly according to baseline CAC (4.2 [2.7–6.7] events in those with CAC=0, 12.8 [8.3–19.9] events in those with CAC >100).ConclusionsIn MESA, compared with ACC/AHA, the USPSTF statin guidelines resulted in a 15% absolute decrease in eligibility. Participants with discordant eligibility had ASCVD rates that varied significantly according to baseline CAC, suggesting CAC could aid clinical decision making for statins in these individuals.

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Statins for Prevention of Cardiovascular Disease in Adults

Abstract: In adults at increased CVD risk but without prior CVD events, statin therapy was associated with reduced risk of all-cause and cardiovascular mortality and CVD events, with greater absolute benefits in patients at greater baseline risk.

Cited by 486 publications

References 71 publications

Effect of Therapeutic Hypothermia Initiated After 6 Hours of Age on Death or Disability Among Newborns With Hypoxic-Ischemic Encephalopathy

Effect of Therapeutic Hypothermia Initiated After 6 Hours of Age on Death or Disability Among Newborns With Hypoxic-Ischemic Encephalopathy

Examining Bias in Studies of Statin Treatment and Survival in Patients With Cancer

Statin Eligibility, Coronary Artery Calcium, and Subsequent Cardiovascular Events According to the 2016 United States Preventive Services Task Force (USPSTF) Statin Guidelines: MESA (Multi‐Ethnic Study of Atherosclerosis)

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