Personalized Prediction of Lifetime Benefits with Statin Therapy for Asymptomatic Individuals: A Modeling Study
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{"title"=>"Personalized Prediction of Lifetime Benefits with Statin Therapy for Asymptomatic Individuals: A Modeling Study", "type"=>"journal", "authors"=>[{"first_name"=>"Bart S.", "last_name"=>"Ferket", "scopus_author_id"=>"35740232900"}, {"first_name"=>"Bob J H", "last_name"=>"van Kempen", "scopus_author_id"=>"35793920500"}, {"first_name"=>"Jan", "last_name"=>"Heeringa", "scopus_author_id"=>"6508107492"}, {"first_name"=>"Sandra", "last_name"=>"Spronk", "scopus_author_id"=>"8654298900"}, {"first_name"=>"Kirsten E.", "last_name"=>"Fleischmann", "scopus_author_id"=>"7006694625"}, {"first_name"=>"Rogier L G", "last_name"=>"Nijhuis", "scopus_author_id"=>"6506071197"}, {"first_name"=>"Albert", "last_name"=>"Hofman", "scopus_author_id"=>"36048731400"}, {"first_name"=>"Ewout W.", "last_name"=>"Steyerberg", "scopus_author_id"=>"7006417148"}, {"first_name"=>"M. G Myriam", "last_name"=>"Hunink", "scopus_author_id"=>"26642922600"}], "year"=>2012, "source"=>"PLoS Medicine", "identifiers"=>{"scopus"=>"2-s2.0-84871667565", "sgr"=>"84871667565", "issn"=>"15491277", "doi"=>"10.1371/journal.pmed.1001361", "pmid"=>"23300388", "isbn"=>"1549-1676 (Electronic)\\r1549-1277 (Linking)", "pui"=>"368006169"}, "id"=>"982b17f4-ead0-3833-aca6-f24a88e9f836", "abstract"=>"BACKGROUND: Physicians need to inform asymptomatic individuals about personalized outcomes of statin therapy for primary prevention of cardiovascular disease (CVD). However, current prediction models focus on short-term outcomes and ignore the competing risk of death due to other causes. We aimed to predict the potential lifetime benefits with statin therapy, taking into account competing risks.\\n\\nMETHODS AND FINDINGS: A microsimulation model based on 5-y follow-up data from the Rotterdam Study, a population-based cohort of individuals aged 55 y and older living in the Ommoord district of Rotterdam, the Netherlands, was used to estimate lifetime outcomes with and without statin therapy. The model was validated in-sample using 10-y follow-up data. We used baseline variables and model output to construct (1) a web-based calculator for gains in total and CVD-free life expectancy and (2) color charts for comparing these gains to the Systematic Coronary Risk Evaluation (SCORE) charts. In 2,428 participants (mean age 67.7 y, 35.5% men), statin therapy increased total life expectancy by 0.3 y (SD 0.2) and CVD-free life expectancy by 0.7 y (SD 0.4). Age, sex, smoking, blood pressure, hypertension, lipids, diabetes, glucose, body mass index, waist-to-hip ratio, and creatinine were included in the calculator. Gains in total and CVD-free life expectancy increased with blood pressure, unfavorable lipid levels, and body mass index after multivariable adjustment. Gains decreased considerably with advancing age, while SCORE 10-y CVD mortality risk increased with age. Twenty-five percent of participants with a low SCORE risk achieved equal or larger gains in CVD-free life expectancy than the median gain in participants with a high SCORE risk.\\n\\nCONCLUSIONS: We developed tools to predict personalized increases in total and CVD-free life expectancy with statin therapy. The predicted gains we found are small. If the underlying model is validated in an independent cohort, the tools may be useful in discussing with patients their individual outcomes with statin therapy.", "link"=>"http://www.mendeley.com/research/personalized-prediction-lifetime-benefits-statin-therapy-asymptomatic-individuals-modeling-study", "reader_count"=>40, "reader_count_by_academic_status"=>{"Professor > Associate Professor"=>5, "Librarian"=>2, "Researcher"=>5, "Student > Ph. D. Student"=>7, "Student > Master"=>5, "Other"=>6, "Student > Bachelor"=>6, "Lecturer"=>1, "Professor"=>3}, "reader_count_by_user_role"=>{"Professor > Associate Professor"=>5, "Librarian"=>2, "Researcher"=>5, "Student > Ph. D. Student"=>7, "Student > Master"=>5, "Other"=>6, "Student > Bachelor"=>6, "Lecturer"=>1, "Professor"=>3}, "reader_count_by_subject_area"=>{"Engineering"=>2, "Unspecified"=>1, "Biochemistry, Genetics and Molecular Biology"=>1, "Medicine and Dentistry"=>21, "Agricultural and Biological Sciences"=>5, "Design"=>1, "Pharmacology, Toxicology and Pharmaceutical Science"=>1, "Psychology"=>1, "Social Sciences"=>2, "Computer Science"=>2, "Decision Sciences"=>1, "Economics, Econometrics and Finance"=>1, "Nursing and Health Professions"=>1}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>21}, "Social Sciences"=>{"Social Sciences"=>2}, "Decision Sciences"=>{"Decision Sciences"=>1}, "Psychology"=>{"Psychology"=>1}, "Unspecified"=>{"Unspecified"=>1}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>1}, "Design"=>{"Design"=>1}, "Engineering"=>{"Engineering"=>2}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>5}, "Computer Science"=>{"Computer Science"=>2}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>1}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>1}}, "reader_count_by_country"=>{"United States"=>1, "Germany"=>2}, "group_count"=>6}

Scopus | Further Information

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  • {"files"=>["https://ndownloader.figshare.com/files/516745"], "description"=>"<p>Note that these charts demonstrate that life expectancy (LE) gained with statin therapy is highest for young non-smoking individuals with otherwise high risk factor levels.</p>", "links"=>[], "tags"=>["expectancy", "statin", "calculated", "risc"], "article_id"=>187232, "categories"=>["Medicine", "Biotechnology"], "users"=>["Bart S. Ferket", "Bob J. H. van Kempen", "Jan Heeringa", "Sandra Spronk", "Kirsten E. Fleischmann", "Rogier L. G. Nijhuis", "Albert Hofman", "Ewout W. Steyerberg", "M. G. Myriam Hunink"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001361.g003", "stats"=>{"downloads"=>1, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_The_gain_in_life_expectancy_in_months_with_statin_therapy_calculated_with_the_RISC_model_/187232", "title"=>"The gain in life expectancy (in months) with statin therapy, calculated with the RISC model.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-12-27 02:00:32"}
  • {"files"=>["https://ndownloader.figshare.com/files/516607"], "description"=>"<p>Schematic representation of the RISC model.</p>", "links"=>[], "tags"=>["risc"], "article_id"=>187099, "categories"=>["Medicine", "Biotechnology"], "users"=>["Bart S. Ferket", "Bob J. H. van Kempen", "Jan Heeringa", "Sandra Spronk", "Kirsten E. Fleischmann", "Rogier L. G. Nijhuis", "Albert Hofman", "Ewout W. Steyerberg", "M. G. Myriam Hunink"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001361.g001", "stats"=>{"downloads"=>1, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Schematic_representation_of_the_RISC_model_/187099", "title"=>"Schematic representation of the RISC model.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-12-27 01:58:19"}
  • {"files"=>["https://ndownloader.figshare.com/files/517225"], "description"=>"<p>Data are mean (SD) unless otherwise indicated. Hypertension is defined as either reporting use of antihypertensive medication or having a systolic blood pressure ≥160 mm Hg or a diastolic blood pressure ≥95 mm Hg. Diabetes mellitus is defined as either reporting use of antidiabetic medication or having a serum glucose level ≥11.0 mmol/l.</p>", "links"=>[], "tags"=>["aged", "55", "cardiovascular", "symptoms"], "article_id"=>187716, "categories"=>["Medicine", "Biotechnology"], "users"=>["Bart S. Ferket", "Bob J. H. van Kempen", "Jan Heeringa", "Sandra Spronk", "Kirsten E. Fleischmann", "Rogier L. G. Nijhuis", "Albert Hofman", "Ewout W. Steyerberg", "M. G. Myriam Hunink"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001361.t001", "stats"=>{"downloads"=>0, "page_views"=>34, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Characteristics_of_2_428_participants_aged_55_y_and_older_free_of_cardiovascular_disease_and_symptoms_at_baseline_/187716", "title"=>"Characteristics of 2,428 participants aged 55 y and older, free of cardiovascular disease and symptoms at baseline.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-12-27 02:08:36"}
  • {"files"=>["https://ndownloader.figshare.com/files/516816"], "description"=>"<p>Note that these charts demonstrate that CHD/stroke-free life expectancy (LE) gained with statin therapy is highest for young individuals with otherwise high risk factor levels.</p>", "links"=>[], "tags"=>["expectancy", "statin", "calculated", "risc"], "article_id"=>187302, "categories"=>["Medicine", "Biotechnology"], "users"=>["Bart S. Ferket", "Bob J. H. van Kempen", "Jan Heeringa", "Sandra Spronk", "Kirsten E. Fleischmann", "Rogier L. G. Nijhuis", "Albert Hofman", "Ewout W. Steyerberg", "M. G. Myriam Hunink"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001361.g004", "stats"=>{"downloads"=>1, "page_views"=>10, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_The_gain_in_CHD_stroke_free_life_expectancy_in_months_with_statin_therapy_calculated_with_the_RISC_model_/187302", "title"=>"The gain in CHD/stroke-free life expectancy (in months) with statin therapy, calculated with the RISC model.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-12-27 02:01:42"}
  • {"files"=>["https://ndownloader.figshare.com/files/517266"], "description"=>"<p>The means, SDs, and ranges are presented to reflect the heterogeneity in the predicted outcomes, and 95% CIs to reflect the parameter uncertainty.</p>", "links"=>[], "tags"=>["outcomes", "changes", "statin", "aged", "55", "cardiovascular", "symptoms"], "article_id"=>187751, "categories"=>["Medicine", "Biotechnology"], "users"=>["Bart S. Ferket", "Bob J. H. van Kempen", "Jan Heeringa", "Sandra Spronk", "Kirsten E. Fleischmann", "Rogier L. G. Nijhuis", "Albert Hofman", "Ewout W. Steyerberg", "M. G. Myriam Hunink"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001361.t002", "stats"=>{"downloads"=>0, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Predicted_outcomes_and_changes_with_statin_therapy_for_the_study_population_n_2_428_aged_55_y_and_older_free_of_cardiovascular_disease_and_symptoms_at_baseline_/187751", "title"=>"Predicted outcomes and changes with statin therapy for the study population (<i>n</i> = 2,428) aged 55 y and older, free of cardiovascular disease and symptoms at baseline.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-12-27 02:09:11"}
  • {"files"=>["https://ndownloader.figshare.com/files/516917"], "description"=>"<p>Note that many individuals with a low SCORE 10-y CVD mortality risk achieved similar or higher gains than those with high SCORE 10-y CVD mortality risk. Ten-year CVD mortality risks were calculated using the SCORE European low-risk equation in 1,047 participants younger than 65 y without cardiovascular disease and/or symptoms at baseline.</p>", "links"=>[], "tags"=>["gains", "expectancy", "10-y", "cvd"], "article_id"=>187407, "categories"=>["Medicine", "Biotechnology"], "users"=>["Bart S. Ferket", "Bob J. H. van Kempen", "Jan Heeringa", "Sandra Spronk", "Kirsten E. Fleischmann", "Rogier L. G. Nijhuis", "Albert Hofman", "Ewout W. Steyerberg", "M. G. Myriam Hunink"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001361.g005", "stats"=>{"downloads"=>0, "page_views"=>2, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Distribution_of_gains_in_total_life_expectancy_according_to_SCORE_10_y_total_CVD_mortality_risk_percent_/187407", "title"=>"Distribution of gains in total life expectancy according to SCORE 10-y total CVD mortality risk (percent).", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-12-27 02:03:27"}
  • {"files"=>["https://ndownloader.figshare.com/files/517089"], "description"=>"<p>Note that many individuals with a low SCORE 10-y CVD mortality risk achieved similar or higher gains than those with high SCORE 10-y CVD mortality risk. Ten-year CVD mortality risks were calculated using the SCORE European low-risk equation in 1,047 participants younger than 65 y without cardiovascular disease and/or symptoms at baseline. SCORE = Systematic COronary Risk Evaluation.</p>", "links"=>[], "tags"=>["gains", "expectancy", "10-y", "cvd"], "article_id"=>187574, "categories"=>["Medicine", "Biotechnology"], "users"=>["Bart S. Ferket", "Bob J. H. van Kempen", "Jan Heeringa", "Sandra Spronk", "Kirsten E. Fleischmann", "Rogier L. G. Nijhuis", "Albert Hofman", "Ewout W. Steyerberg", "M. G. Myriam Hunink"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001361.g006", "stats"=>{"downloads"=>1, "page_views"=>12, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Distribution_of_gains_in_CHD_stroke_free_life_expectancy_according_to_SCORE_10_y_total_CVD_mortality_risk_percent_/187574", "title"=>"Distribution of gains in CHD/stroke-free life expectancy according to SCORE 10-y total CVD mortality risk (percent).", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-12-27 02:06:14"}
  • {"files"=>["https://ndownloader.figshare.com/files/517314"], "description"=>"<p>Hypertension is defined as either reporting use of antihypertensive medication or having a systolic blood pressure ≥160 mm Hg or a diastolic blood pressure ≥95 mm Hg; diabetes is defined as either reporting use of antidiabetic medication or having a serum glucose level ≥11.0 mmol/l. Predictions for lifetime CHD/stroke incidence, CHD/stroke mortality, and total CVD mortality for these risk profiles, are shown in the <a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001361#pmed.1001361.s005\" target=\"_blank\">Table S2</a>.</p><p>Conventional conversion factors: to convert HDL and total cholesterol to milligrams per deciliter, divide by 0.0259; creatinine to milligrams per deciliter, divide by 88.4; glucose to milligrams per deciliter, divide by 0.0555.</p>a<p>The gain in total life expectancy in years can be computed as follows: 0.2632−0.0077×age (in years)+0.0138×[1 if male sex, 0 if not]−0.0115×[1 if current cigarette smoker, 0 if not]+0.0023×systolic blood pressure (in mm Hg)−0.0018×diastolic blood pressure (in mm Hg)+0.0479×[1 if hypertension, 0 if not]+0.0548×total cholesterol (in mmol/l)−0.1448×HDL cholesterol (in mmol/l)−0.0218×[1 if diabetes mellitus, 0 if not]+0.0086×serum glucose (in mmol/l)+0.0099×body mass index (in kg/m<sup>2</sup>)−0.3989×waist-to-hip ratio+0.0025×serum creatinine (in µmol/l).</p>b<p>The gain in CHD/stroke-life expectancy in years can be computed as follows: 1.8854−0.0330×age (in years)+0.0470×[1 if male sex, 0 if not]+0.0049×systolic blood pressure (in mm Hg)−0.0040×diastolic blood pressure (in mm Hg)+0.1157×total cholesterol (in mmol/l)−0.3605×HDL cholesterol (in mmol/l)−0.0899×[1 if diabetes mellitus, 0 if not]+0.0049×serum glucose (in mmol/l)+0.0175×body mass index (in kg/m<sup>2</sup>)−0.2915×waist-to-hip ratio+0.0023×serum creatinine (in µmol/l).</p><p>BMI, body mass index; WHR, waist-to-hip ratio.</p>", "links"=>[], "tags"=>["expectancy", "statin", "compared", "10-y", "cvd"], "article_id"=>187799, "categories"=>["Medicine", "Biotechnology"], "users"=>["Bart S. Ferket", "Bob J. H. van Kempen", "Jan Heeringa", "Sandra Spronk", "Kirsten E. Fleischmann", "Rogier L. G. Nijhuis", "Albert Hofman", "Ewout W. Steyerberg", "M. G. Myriam Hunink"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001361.t003", "stats"=>{"downloads"=>1, "page_views"=>8, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Changes_916_in_total_life_expectancy_and_CHD_stroke_free_life_expectancy_with_statin_therapy_compared_with_predicted_10_y_total_CVD_mortality_risk_for_different_risk_factor_profiles_/187799", "title"=>"Changes (Δ) in total life expectancy and CHD/stroke-free life expectancy with statin therapy, compared with predicted 10-y total CVD mortality risk for different risk factor profiles.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-12-27 02:09:59"}
  • {"files"=>["https://ndownloader.figshare.com/files/279633", "https://ndownloader.figshare.com/files/279666", "https://ndownloader.figshare.com/files/279691", "https://ndownloader.figshare.com/files/279724", "https://ndownloader.figshare.com/files/279804", "https://ndownloader.figshare.com/files/279866"], "description"=>"<div><h3>Background</h3><p>Physicians need to inform asymptomatic individuals about personalized outcomes of statin therapy for primary prevention of cardiovascular disease (CVD). However, current prediction models focus on short-term outcomes and ignore the competing risk of death due to other causes. We aimed to predict the potential lifetime benefits with statin therapy, taking into account competing risks.</p> <h3>Methods and Findings</h3><p>A microsimulation model based on 5-y follow-up data from the Rotterdam Study, a population-based cohort of individuals aged 55 y and older living in the Ommoord district of Rotterdam, the Netherlands, was used to estimate lifetime outcomes with and without statin therapy. The model was validated in-sample using 10-y follow-up data. We used baseline variables and model output to construct (1) a web-based calculator for gains in total and CVD-free life expectancy and (2) color charts for comparing these gains to the Systematic Coronary Risk Evaluation (SCORE) charts. In 2,428 participants (mean age 67.7 y, 35.5% men), statin therapy increased total life expectancy by 0.3 y (SD 0.2) and CVD-free life expectancy by 0.7 y (SD 0.4). Age, sex, smoking, blood pressure, hypertension, lipids, diabetes, glucose, body mass index, waist-to-hip ratio, and creatinine were included in the calculator. Gains in total and CVD-free life expectancy increased with blood pressure, unfavorable lipid levels, and body mass index after multivariable adjustment. Gains decreased considerably with advancing age, while SCORE 10-y CVD mortality risk increased with age. Twenty-five percent of participants with a low SCORE risk achieved equal or larger gains in CVD-free life expectancy than the median gain in participants with a high SCORE risk.</p> <h3>Conclusions</h3><p>We developed tools to predict personalized increases in total and CVD-free life expectancy with statin therapy. The predicted gains we found are small. If the underlying model is validated in an independent cohort, the tools may be useful in discussing with patients their individual outcomes with statin therapy.</p> <p> <em>Please see later in the article for the Editors' Summary</em></p> </div>", "links"=>[], "tags"=>["personalized", "benefits", "statin", "asymptomatic", "modeling", "study"], "article_id"=>115131, "categories"=>["Medicine", "Biotechnology"], "users"=>["Bart S. Ferket", "Bob J. H. van Kempen", "Jan Heeringa", "Sandra Spronk", "Kirsten E. Fleischmann", "Rogier L. G. Nijhuis", "Albert Hofman", "Ewout W. Steyerberg", "M. G. Myriam Hunink"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1001361.s001", "https://dx.doi.org/10.1371/journal.pmed.1001361.s002", "https://dx.doi.org/10.1371/journal.pmed.1001361.s003", "https://dx.doi.org/10.1371/journal.pmed.1001361.s004", "https://dx.doi.org/10.1371/journal.pmed.1001361.s005", "https://dx.doi.org/10.1371/journal.pmed.1001361.s006"], "stats"=>{"downloads"=>37, "page_views"=>10, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Personalized_Prediction_of_Lifetime_Benefits_with_Statin_Therapy_for_Asymptomatic_Individuals_A_Modeling_Study__/115131", "title"=>"Personalized Prediction of Lifetime Benefits with Statin Therapy for Asymptomatic Individuals: A Modeling Study", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2012-12-27 01:25:31"}
  • {"files"=>["https://ndownloader.figshare.com/files/516676"], "description"=>"<p>Adapted with permission from the European Society of Cardiology. Copyright: © 2007 Oxford University Press. Note that these charts demonstrate that the 10-y total CVD mortality risk is highest for elderly smoking individuals with otherwise high risk factor levels, suggesting that these individuals would benefit most from statin therapy.</p>", "links"=>[], "tags"=>["cvd", "european", "low-risk"], "article_id"=>187166, "categories"=>["Medicine", "Biotechnology"], "users"=>["Bart S. Ferket", "Bob J. H. van Kempen", "Jan Heeringa", "Sandra Spronk", "Kirsten E. Fleischmann", "Rogier L. G. Nijhuis", "Albert Hofman", "Ewout W. Steyerberg", "M. G. Myriam Hunink"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001361.g002", "stats"=>{"downloads"=>10, "page_views"=>568, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Ten_year_total_CVD_mortality_risk_percent_predicted_by_SCORE_European_low_risk_charts_/187166", "title"=>"Ten-year total CVD mortality risk (percent) predicted by SCORE European low-risk charts.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-12-27 01:59:26"}

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Relative Metric

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