Population Impact & Efficiency of Benefit‐Targeted Versus Risk‐Targeted Statin Prescribing for Primary Prevention of Cardiovascular Disease

Abstract

BackgroundBenefit‐targeted statin prescribing may be superior to risk‐targeted statin prescribing (the current standard), but the impact and efficiency of this approach are unclear.Methods and ResultsWe analyzed the National Health and Nutrition Examination Survey (NHANES) using an open‐source model (the Prevention Impact and Efficiency Model) to compare targeting of statin therapy according to expected benefit (benefit‐targeted) versus baseline risk (risk‐targeted) in terms of projected population‐level impact and efficiency. Impact was defined as relative % reduction in atherosclerotic cardiovascular disease in the US population for the given strategy compared to current statin treatment patterns; and efficiency as the number needed to treat over 10 years (NNT 10, average and maximum) to prevent each atherosclerotic cardiovascular disease event. Benefit‐targeted moderate‐intensity statin therapy at a treatment threshold of 2.3% expected 10‐year absolute risk reduction could produce a 5.7% impact (95% confidence interval, 4.8–6.7). This is approximately equivalent to the potential impact of risk‐targeted therapy at a treatment threshold of 5% 10‐year atherosclerotic cardiovascular disease risk (5.6% impact [4.7–6.6]). Whereas the estimated maximum NNT 10 is much improved for benefit‐targeted versus risk‐targeted therapy at these equivalent‐impact thresholds (43.5 vs 180), the average NNT 10 is nearly equivalent (24.2 vs 24.6). Reaching 10% impact (half the Healthy People 2020 impact objective, loosely defined) is theoretically possible with benefit‐targeted moderate‐intensity statins of persons with expected absolute risk reduction >2.3% if we expand age eligibility and account for treatment of all persons with diabetes mellitus or with low‐density lipoprotein >190 mg/dL (impact=12.4%; average NNT 10=23.0).ConclusionsBenefit‐based targeting of statin therapy provides modest gains in efficiency over risk‐based prescribing and could theoretically help attain approximately half of the Healthy People 2020 impact goal with reasonable efficiency.

Recycling the Purpose of Old Drugs to Treat Ovarian Cancer

“…Statins are inhibitors of 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR), located upstream in the mevalonate pathway, which is responsible for cholesterol biosynthesis [ 22 , 23 , 24 ]. The main clinical use of statins is to reduce plasma cholesterol levels, being a key treatment in the prevention of cardiovascular diseases [ 25 , 26 , 27 , 28 , 29 ]. Statins can also reduce inflammation, influence vascular expansion and remodelling, and inhibit coagulation and fibrinolysis [ 30 , 31 , 32 ].…”

Baseline, delta, and achieved low‐density lipoprotein cholesterol levels and cardiovascular risk in patients on statin therapy: A post‐hoc resampling mediation analysis of treating new targets [TNT] trial

“…usual real-world clinical settings and can potentially bias prediction of patient survivals after statin therapy. As we described in this study, achieved LDL-C lowering did not fully explain the remaining effects of baseline LDL-C and ΔLDL-C. Because the absolute value of LDL-C reduction is directly proportional to baseline LDL-C,,4,7,8 the benefits of statin treatment may not be similar in patients with low and high risk of future atherosclerotic CVD according to baseline LDL-C 25,26. The absolute values of ΔLDL-C and achieved LDL-C are conventional biomarkers for statin users, based on the assumptions that LDL-C contributes to atherogenic plaque progression and that statins alter the cholesterol biosynthesis pathway.…”

Current state and outlook for drug repositioning anticipated in the field of ovarian cancer

“…They also exhibit multifaceted effects, including inflammation reduction, vascular expansion, and vascular remodeling inhibition via coagulation and fibrinolysis [151617]. Moreover, some reports have indicated that statins could be effective for preventing diseases, such as coronary artery disease, heart failure, and arrhythmia [1819].…”