Postponement of Death by Statin Use

a Systematic Review and Meta-analysis of Randomized Clinical Trials

Morten Rix Hansen*, Asbjørn Hróbjartsson, Anton Pottegård, Per Damkier, Kasper Søltoft Larsen, Kenneth Grønkjær Madsen, René dePont Christensen, Malene Elisa Lopez Kristensen, Palle Mark Christensen, Jesper Hallas

*Kontaktforfatter for dette arbejde

Publikation: Bidrag til tidsskriftReviewForskningpeer review

Resumé

Background: The average postponement of the outcome (gain in time to event) has been proposed as a measure to convey the effect of preventive medications. Among its advantages over number needed to treat and relative risk reduction is a better intuitive understanding among lay persons. Objectives: To develop a novel approach for modeling outcome postponement achieved within a trial’s duration, based on published trial data and to present a formalized meta-analysis of modeled outcome postponement for all-cause mortality in statin trials. Methods: The outcome postponement was modeled on the basis of the hazard ratio or relative risk, the mortality rate in the placebo group and the trial’s duration. Outcome postponement was subjected to a meta-analysis. We also estimated the average outcome postponement as the area between Kaplan–Meier curves. Statin trials were identified through a systematic review. Results: The median modeled outcome postponement was 10.0 days (interquartile range, 2.9–19.5 days). Meta-analysis of 16 trials provided a summary estimate of outcome postponement for all-cause mortality of 12.6 days, with a 95% postponement interval (PI) of 7.1–18.0. For primary, secondary, and mixed prevention trials, respectively, outcome postponements were 10.2 days (PI, 4.0–16.3), 17.4 days (PI, 6.0–28.8), and 8.5 days (PI, 1.9–15.0). Conclusions: The modeled outcome postponement is amenable to meta-analysis and may be a useful approach for presenting the benefits of preventive interventions. Statin treatment results in a small increase of average survival within the duration of a trial. Systematic Review Registration: The systematic review was registered in PROSPERO [CRD42016037507].

OriginalsprogEngelsk
TidsskriftJournal of General Internal Medicine
Vol/bind34
Udgave nummer8
Sider (fra-til)1607-1614
ISSN0884-8734
DOI
StatusUdgivet - 15. aug. 2019

Fingeraftryk

Hydroxymethylglutaryl-CoA Reductase Inhibitors
Meta-Analysis
Randomized Controlled Trials
Numbers Needed To Treat
Risk Reduction Behavior
Placebos

Citer dette

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title = "Postponement of Death by Statin Use: a Systematic Review and Meta-analysis of Randomized Clinical Trials",
abstract = "Background: The average postponement of the outcome (gain in time to event) has been proposed as a measure to convey the effect of preventive medications. Among its advantages over number needed to treat and relative risk reduction is a better intuitive understanding among lay persons. Objectives: To develop a novel approach for modeling outcome postponement achieved within a trial’s duration, based on published trial data and to present a formalized meta-analysis of modeled outcome postponement for all-cause mortality in statin trials. Methods: The outcome postponement was modeled on the basis of the hazard ratio or relative risk, the mortality rate in the placebo group and the trial’s duration. Outcome postponement was subjected to a meta-analysis. We also estimated the average outcome postponement as the area between Kaplan–Meier curves. Statin trials were identified through a systematic review. Results: The median modeled outcome postponement was 10.0 days (interquartile range, 2.9–19.5 days). Meta-analysis of 16 trials provided a summary estimate of outcome postponement for all-cause mortality of 12.6 days, with a 95{\%} postponement interval (PI) of 7.1–18.0. For primary, secondary, and mixed prevention trials, respectively, outcome postponements were 10.2 days (PI, 4.0–16.3), 17.4 days (PI, 6.0–28.8), and 8.5 days (PI, 1.9–15.0). Conclusions: The modeled outcome postponement is amenable to meta-analysis and may be a useful approach for presenting the benefits of preventive interventions. Statin treatment results in a small increase of average survival within the duration of a trial. Systematic Review Registration: The systematic review was registered in PROSPERO [CRD42016037507].",
author = "Hansen, {Morten Rix} and Asbj{\o}rn Hr{\'o}bjartsson and Anton Potteg{\aa}rd and Per Damkier and Larsen, {Kasper S{\o}ltoft} and Madsen, {Kenneth Gr{\o}nkj{\ae}r} and {dePont Christensen}, Ren{\'e} and Kristensen, {Malene Elisa Lopez} and Christensen, {Palle Mark} and Jesper Hallas",
year = "2019",
month = "8",
day = "15",
doi = "10.1007/s11606-019-05024-4",
language = "English",
volume = "34",
pages = "1607--1614",
journal = "Journal of General Internal Medicine",
issn = "0884-8734",
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TY - JOUR

T1 - Postponement of Death by Statin Use

T2 - a Systematic Review and Meta-analysis of Randomized Clinical Trials

AU - Hansen, Morten Rix

AU - Hróbjartsson, Asbjørn

AU - Pottegård, Anton

AU - Damkier, Per

AU - Larsen, Kasper Søltoft

AU - Madsen, Kenneth Grønkjær

AU - dePont Christensen, René

AU - Kristensen, Malene Elisa Lopez

AU - Christensen, Palle Mark

AU - Hallas, Jesper

PY - 2019/8/15

Y1 - 2019/8/15

N2 - Background: The average postponement of the outcome (gain in time to event) has been proposed as a measure to convey the effect of preventive medications. Among its advantages over number needed to treat and relative risk reduction is a better intuitive understanding among lay persons. Objectives: To develop a novel approach for modeling outcome postponement achieved within a trial’s duration, based on published trial data and to present a formalized meta-analysis of modeled outcome postponement for all-cause mortality in statin trials. Methods: The outcome postponement was modeled on the basis of the hazard ratio or relative risk, the mortality rate in the placebo group and the trial’s duration. Outcome postponement was subjected to a meta-analysis. We also estimated the average outcome postponement as the area between Kaplan–Meier curves. Statin trials were identified through a systematic review. Results: The median modeled outcome postponement was 10.0 days (interquartile range, 2.9–19.5 days). Meta-analysis of 16 trials provided a summary estimate of outcome postponement for all-cause mortality of 12.6 days, with a 95% postponement interval (PI) of 7.1–18.0. For primary, secondary, and mixed prevention trials, respectively, outcome postponements were 10.2 days (PI, 4.0–16.3), 17.4 days (PI, 6.0–28.8), and 8.5 days (PI, 1.9–15.0). Conclusions: The modeled outcome postponement is amenable to meta-analysis and may be a useful approach for presenting the benefits of preventive interventions. Statin treatment results in a small increase of average survival within the duration of a trial. Systematic Review Registration: The systematic review was registered in PROSPERO [CRD42016037507].

AB - Background: The average postponement of the outcome (gain in time to event) has been proposed as a measure to convey the effect of preventive medications. Among its advantages over number needed to treat and relative risk reduction is a better intuitive understanding among lay persons. Objectives: To develop a novel approach for modeling outcome postponement achieved within a trial’s duration, based on published trial data and to present a formalized meta-analysis of modeled outcome postponement for all-cause mortality in statin trials. Methods: The outcome postponement was modeled on the basis of the hazard ratio or relative risk, the mortality rate in the placebo group and the trial’s duration. Outcome postponement was subjected to a meta-analysis. We also estimated the average outcome postponement as the area between Kaplan–Meier curves. Statin trials were identified through a systematic review. Results: The median modeled outcome postponement was 10.0 days (interquartile range, 2.9–19.5 days). Meta-analysis of 16 trials provided a summary estimate of outcome postponement for all-cause mortality of 12.6 days, with a 95% postponement interval (PI) of 7.1–18.0. For primary, secondary, and mixed prevention trials, respectively, outcome postponements were 10.2 days (PI, 4.0–16.3), 17.4 days (PI, 6.0–28.8), and 8.5 days (PI, 1.9–15.0). Conclusions: The modeled outcome postponement is amenable to meta-analysis and may be a useful approach for presenting the benefits of preventive interventions. Statin treatment results in a small increase of average survival within the duration of a trial. Systematic Review Registration: The systematic review was registered in PROSPERO [CRD42016037507].

U2 - 10.1007/s11606-019-05024-4

DO - 10.1007/s11606-019-05024-4

M3 - Review

VL - 34

SP - 1607

EP - 1614

JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

SN - 0884-8734

IS - 8

ER -