Case Study: Survival Benefits of Statins for Primary Prevention of Cardiovascular Disease

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Case Study: Survival Benefits of Statins for Primary Prevention of Cardiovascular Disease

 

Abstract

The research’s objective was to calculate survival prospects after statin prescription in the population of England and Wales with no previous history of cardiovascular disease.

Research overview

Cardiovascular disease is one of the main causes of death in the world, accounting for 33% of all deaths. Statins have been widely prescribed for primary and secondary prevention of cardiovascular disease. Current international guidelines recommend statins for primary prevention of cardiovascular disease when the 10-year risk of a first cardiovascular event is 10% or higher. Previously, the risk-threshold was 20%. The main evidence base to date comes from clinical trials, which tend to have high reliability but may be poorly generalisable due to excluding many patients who will be treated in routine practice, such as those with multiple comorbidities, on multiple drugs, of older age, and at lower risk of cardiovascular disease. Furthermore, clinical trials tend to have a follow-up time of up to 5 years, which is shorter than the treatment times in routine practice.

How the research helps

This large observational population-based cohort study was representative of the full range of patients seen in routine clinical practice, including large numbers of people at low risk and of people at older ages. There were enough variables to categorise participants by cardiac risk scores (QRISK2).

This research found no survival benefit for statin prescription initiated in people with a cardiac risk score of <10% at any age, possible survival benefit with a cardiac risk score of 10-19% from age 70 onwards, and significant survival benefit with a cardiac risk score of ≥20% from age 65 onwards.

The survival benefit for statin prescription in people with a cardiac risk score of ≥20% translates to a decrease in effective age (how old a person’s body really is) of 1.5 years if initiated by age 65, 1.9 years if initiated by age 70, and 2.0 years if initiated by age 75.

Implications

These findings suggest that the current internationally recommended thresholds for statin therapy for primary prevention of cardiovascular disease in routine clinical practice are too low, and may lead to overtreatment, particularly of people under 60 and at low (<10%) risk.

Further information and links

Citation: Gitsels LA, Kulinskaya E, Steel N (2016) Survival Benefits of Statins for Primary Prevention: A Cohort Study. PLoS ONE 11(11): e0166847. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0166847

Report Author(s): Dr Lisanne Gitsels, University of East Anglia

Principal Investigator: Prof Elena Kulinskaya, University of East Anglia