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Survival Benefits of Statins for Primary Prevention: A Cohort Study

OBJECTIVES: Estimate the effect of statin prescription on mortality in the population of England and Wales with no previous history of cardiovascular disease. METHODS: Primary care records from The Health Improvement Network 1987–2011 were used. Four cohorts of participants aged 60, 65, 70, or 75 ye...

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Autores principales: Gitsels, Lisanne A., Kulinskaya, Elena, Steel, Nicholas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5115824/
https://www.ncbi.nlm.nih.gov/pubmed/27861639
http://dx.doi.org/10.1371/journal.pone.0166847
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author Gitsels, Lisanne A.
Kulinskaya, Elena
Steel, Nicholas
author_facet Gitsels, Lisanne A.
Kulinskaya, Elena
Steel, Nicholas
author_sort Gitsels, Lisanne A.
collection PubMed
description OBJECTIVES: Estimate the effect of statin prescription on mortality in the population of England and Wales with no previous history of cardiovascular disease. METHODS: Primary care records from The Health Improvement Network 1987–2011 were used. Four cohorts of participants aged 60, 65, 70, or 75 years at baseline included 118,700, 199,574, 247,149, and 194,085 participants; and 1.4, 1.9, 1.8, and 1.1 million person-years of data, respectively. The exposure was any statin prescription at any time before the participant reached the baseline age (60, 65, 70 or 75) and the outcome was all-cause mortality at any age above the baseline age. The hazard of mortality associated with statin prescription was calculated by Cox’s proportional hazard regressions, adjusted for sex, year of birth, socioeconomic status, diabetes, antihypertensive medication, hypercholesterolaemia, body mass index, smoking status, and general practice. Participants were grouped by QRISK2 baseline risk of a first cardiovascular event in the next ten years of <10%, 10–19%, or ≥20%. RESULTS: There was no reduction in all-cause mortality for statin prescription initiated in participants with a QRISK2 score <10% at any baseline age, or in participants aged 60 at baseline in any risk group. Mortality was lower in participants with a QRISK2 score ≥20% if statin prescription had been initiated by age 65 (adjusted hazard ratio (HR) 0.86 (0.79–0.94)), 70 (HR 0.83 (0.79–0.88)), or 75 (HR 0.82 (0.79–0.86)). Mortality reduction was uncertain with a QRISK2 score of 10–19%: the HR was 1.00 (0.91–1.11) for statin prescription by age 65, 0.89 (0.81–0.99) by age 70, or 0.79 (0.52–1.19) by age 75. CONCLUSIONS: The current internationally recommended thresholds for statin therapy for primary prevention of cardiovascular disease in routine practice may be too low and may lead to overtreatment of younger people and those at low risk.
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spelling pubmed-51158242016-12-08 Survival Benefits of Statins for Primary Prevention: A Cohort Study Gitsels, Lisanne A. Kulinskaya, Elena Steel, Nicholas PLoS One Research Article OBJECTIVES: Estimate the effect of statin prescription on mortality in the population of England and Wales with no previous history of cardiovascular disease. METHODS: Primary care records from The Health Improvement Network 1987–2011 were used. Four cohorts of participants aged 60, 65, 70, or 75 years at baseline included 118,700, 199,574, 247,149, and 194,085 participants; and 1.4, 1.9, 1.8, and 1.1 million person-years of data, respectively. The exposure was any statin prescription at any time before the participant reached the baseline age (60, 65, 70 or 75) and the outcome was all-cause mortality at any age above the baseline age. The hazard of mortality associated with statin prescription was calculated by Cox’s proportional hazard regressions, adjusted for sex, year of birth, socioeconomic status, diabetes, antihypertensive medication, hypercholesterolaemia, body mass index, smoking status, and general practice. Participants were grouped by QRISK2 baseline risk of a first cardiovascular event in the next ten years of <10%, 10–19%, or ≥20%. RESULTS: There was no reduction in all-cause mortality for statin prescription initiated in participants with a QRISK2 score <10% at any baseline age, or in participants aged 60 at baseline in any risk group. Mortality was lower in participants with a QRISK2 score ≥20% if statin prescription had been initiated by age 65 (adjusted hazard ratio (HR) 0.86 (0.79–0.94)), 70 (HR 0.83 (0.79–0.88)), or 75 (HR 0.82 (0.79–0.86)). Mortality reduction was uncertain with a QRISK2 score of 10–19%: the HR was 1.00 (0.91–1.11) for statin prescription by age 65, 0.89 (0.81–0.99) by age 70, or 0.79 (0.52–1.19) by age 75. CONCLUSIONS: The current internationally recommended thresholds for statin therapy for primary prevention of cardiovascular disease in routine practice may be too low and may lead to overtreatment of younger people and those at low risk. Public Library of Science 2016-11-18 /pmc/articles/PMC5115824/ /pubmed/27861639 http://dx.doi.org/10.1371/journal.pone.0166847 Text en © 2016 Gitsels et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Gitsels, Lisanne A.
Kulinskaya, Elena
Steel, Nicholas
Survival Benefits of Statins for Primary Prevention: A Cohort Study
title Survival Benefits of Statins for Primary Prevention: A Cohort Study
title_full Survival Benefits of Statins for Primary Prevention: A Cohort Study
title_fullStr Survival Benefits of Statins for Primary Prevention: A Cohort Study
title_full_unstemmed Survival Benefits of Statins for Primary Prevention: A Cohort Study
title_short Survival Benefits of Statins for Primary Prevention: A Cohort Study
title_sort survival benefits of statins for primary prevention: a cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5115824/
https://www.ncbi.nlm.nih.gov/pubmed/27861639
http://dx.doi.org/10.1371/journal.pone.0166847
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