Projections of incident atherosclerotic cardiovascular disease and incident type 2 diabetes across evolving statin treatment guidelines and recommendations: A modelling study


Autoři: Joseph C. Engeda aff001;  Stefan K. Lhachimi aff003;  Wayne D. Rosamond aff001;  Jennifer L. Lund aff001;  Thomas C. Keyserling aff005;  Monika M. Safford aff006;  Lisandro D. Colantonio aff007;  Paul Muntner aff007;  Christy L. Avery aff001
Působiště autorů: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America aff001;  Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America aff002;  Research Group Evidence-Based Public Health, Leibniz Institute for Epidemiology and Prevention Research (BIPS), Bremen, Germany aff003;  Department for Health Services Research, Institute for Public Health and Nursing, University of Bremen, Bremen, Germany aff004;  Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, North Carolina, United States of America aff005;  Division of General Internal Medicine, Weill Cornell Medical College, New York, New York, United States of America aff006;  Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America aff007
Vyšlo v časopise: Projections of incident atherosclerotic cardiovascular disease and incident type 2 diabetes across evolving statin treatment guidelines and recommendations: A modelling study. PLoS Med 17(8): e32767. doi:10.1371/journal.pmed.1003280
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003280

Souhrn

Background

Experimental and observational research has suggested the potential for increased type 2 diabetes (T2D) risk among populations taking statins for the primary prevention of atherosclerotic cardiovascular disease (ASCVD). However, few studies have directly compared statin-associated benefits and harms or examined heterogeneity by population subgroups or assumed treatment effect. Thus, we compared ASCVD risk reduction and T2D incidence increases across 3 statin treatment guidelines or recommendations among adults without a history of ASCVD or T2D who were eligible for statin treatment initiation.

Methods and findings

Simulations were conducted using Markov models that integrated data from contemporary population-based studies of non-Hispanic African American and white adults aged 40–75 years with published meta-analyses. Statin treatment eligibility was determined by predicted 10-year ASCVD risk (5%, 7.5%, or 10%). We calculated the number needed to treat (NNT) to prevent one ASCVD event and the number needed to harm (NNH) to incur one incident case of T2D. The likelihood to be helped or harmed (LHH) was calculated as ratio of NNH to NNT. Heterogeneity in statin-associated benefit was examined by sex, age, and statin-associated T2D relative risk (RR) (range: 1.11–1.55). A total of 61,125,042 U.S. adults (58.5% female; 89.4% white; mean age = 54.7 years) composed our primary prevention population, among whom 13–28 million adults were eligible for statin initiation. Overall, the number of ASCVD events prevented was at least twice as large as the number of incident cases of T2D incurred (LHH range: 2.26–2.90). However, the number of T2D cases incurred surpassed the number of ASCVD events prevented when higher statin-associated T2D RRs were assumed (LHH range: 0.72–0.94). In addition, females (LHH range: 1.74–2.40) and adults aged 40–50 years (LHH range: 1.00–1.14) received lower absolute benefits of statin treatment compared with males (LHH range: 2.55–3.00) and adults aged 70–75 years (LHH range: 3.95–3.96). Projected differences in LHH by age and sex became more pronounced as statin-associated T2D RR increased, with a majority of scenarios projecting LHHs < 1 for females and adults aged 40–50 years. This study’s primary limitation was uncertainty in estimates of statin-associated T2D risk, highlighting areas in which additional clinical and public health research is needed.

Conclusions

Our projections suggest that females and younger adult populations shoulder the highest relative burden of statin-associated T2D risk.

Klíčová slova:

African American people – Cardiovascular disease risk – Epidemiology – Medical risk factors – Statins – Treatment guidelines – Type 2 diabetes – Type 2 diabetes risk


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