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Evaluation of Time to Benefit of Statins for the Primary Prevention of Cardiovascular Events in Adults Aged 50 to 75 YearsA Meta-analysis

Educational Objective: To determine the time to benefit for prevention of a first major adverse cardiovascular event (MACE) in adults aged 50 to 75 years based on randomized clinical trials of statins.
1 Credit CME
JAMA Internal Medicine
Published Online: November 16, 2020
Original Investigation
Lindsey C. Yourman, MD1;
Irena S. Cenzer, MA2;
W. John Boscardin, PhD2,3;
Brian T. Nguyen, BA2,3,4;
Alexander K. Smith, MD, MPH2,3;
Mara A. Schonberg, MD, MPH5,6;
Nancy L. Schoenborn, MD, MHS7;
Eric W. Widera, MD2,3;
Ariela Orkaby, MD, MPH7,8,9;
Annette Rodriguez, MA2,3,4;
Sei J. Lee, MD, MAS2,3
Author Affiliations
  • 1Division of Geriatrics and Gerontology, School of Medicine, University of California, San Diego
  • 2Geriatrics, Palliative and Extended Care Service Line, San Francisco VA (Veterans Affairs) Health Care System, San Francisco, California
  • 3Division of Geriatrics, School of Medicine, University of California, San Francisco
  • 4Northern California Institute for Research and Education, San Francisco
  • 5Department of Medicine, Harvard Medical School, Cambridge, Massachusetts
  • 6Department of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
  • 7Division of Geriatric Medicine and Gerontology, School of Medicine, John Hopkins University, Baltimore, Maryland
  • 8New England GRECC (Geriatrics Research, Education and Clinical Center), VA Boston Healthcare System, Boston, Massachusetts
  • 9Division of Aging, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Key Points

Question  What is the time to benefit of statin therapy for primary prevention of cardiovascular events in adults aged 50 to 75 years?

Findings  In this survival meta-analysis of 8 trials randomizing 65 383 adults, 2.5 (95% CI, 1.7-3.4) years were needed to avoid 1 cardiovascular event for 100 patients treated with a statin.

Meaning  These findings suggest that statin medications for the primary prevention of cardiovascular events may reduce cardiac events for some adults aged 50 to 75 years with a life expectancy of at least 2.5 years; no data suggest a mortality benefit.

Abstract

Importance  Guidelines recommend targeting preventive interventions toward older adults whose life expectancy is greater than the intervention’s time to benefit (TTB). The TTB for statin therapy is unknown.

Objective  To conduct a survival meta-analysis of randomized clinical trials of statins to determine the TTB for prevention of a first major adverse cardiovascular event (MACE) in adults aged 50 to 75 years.

Data Sources  Studies were identified from previously published systematic reviews (Cochrane Database of Systematic Reviews and US Preventive Services Task Force) and a search of MEDLINE and Google Scholar for subsequently published studies until February 1, 2020.

Study Selection  Randomized clinical trials of statins for primary prevention focusing on older adults (mean age >55 years).

Data Extraction and Synthesis  Two authors independently abstracted survival data for the control and intervention groups. Weibull survival curves were fit, and a random-effects model was used to estimate pooled absolute risk reductions (ARRs) between control and intervention groups each year. Markov chain Monte Carlo methods were applied to determine time to ARR thresholds.

Main Outcomes and Measures  The primary outcome was time to ARR thresholds (0.002, 0.005, and 0.010) for a first MACE, as defined by each trial. There were broad similarities in the definition of MACE across trials, with all trials including myocardial infarction and cardiovascular mortality.

Results  Eight trials randomizing 65 383 adults (66.3% men) were identified. The mean age ranged from 55 to 69 years old and the mean length of follow-up ranged from 2 to 6 years. Only 1 of 8 studies showed that statins decreased all-cause mortality. The meta-analysis results suggested that 2.5 (95% CI, 1.7-3.4) years were needed to avoid 1 MACE for 100 patients treated with a statin. To prevent 1 MACE for 200 patients treated (ARR = 0.005), the TTB was 1.3 (95% CI, 1.0-1.7) years, whereas the TTB to avoid 1 MACE for 500 patients treated (ARR = 0.002) was 0.8 (95% CI, 0.5-1.0) years.

Conclusions and Relevance  These findings suggest that treating 100 adults (aged 50-75 years) without known cardiovascular disease with a statin for 2.5 years prevented 1 MACE in 1 adult. Statins may help to prevent a first MACE in adults aged 50 to 75 years old if they have a life expectancy of at least 2.5 years. There is no evidence of a mortality benefit.

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Cardiology Clinical Pharmacy and Pharmacology Geriatrics Dyslipidemia Cardiovascular Risk Factors Less is More
Article Information

Accepted for Publication: September 6, 2020.

Published Online: November 16, 2020. doi:10.1001/jamainternmed.2020.6084

Corresponding Author: Lindsey C. Yourman, MD, Division of Geriatrics and Gerontology, School of Medicine, University of California, San Diego, 9500 Gilman Dr, MC 0665, Central Research Services Facility, Third Floor, Cubicle 331, La Jolla, CA 92107 (lyourman@health.ucsd.edu).

Author Contributions: Drs Yourman and Lee had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Yourman, Smith, Schonberg, Schoenborn, Widera, Rodriguez, Lee.

Acquisition, analysis, or interpretation of data: Yourman, Cenzer, Boscardin, Nguyen, Schoenborn, Orkaby, Rodriguez, Lee.

Drafting of the manuscript: Yourman, Schonberg, Rodriguez, Lee.

Critical revision of the manuscript for important intellectual content: Yourman, Cenzer, Boscardin, Nguyen, Smith, Schoenborn, Widera, Orkaby, Lee.

Statistical analysis: Cenzer, Boscardin, Rodriguez.

Obtained funding: Schonberg, Lee.

Administrative, technical, or material support: Yourman, Nguyen, Widera, Lee.

Supervision: Yourman, Smith, Lee.

Conflict of Interest Disclosures: Dr Yourman reported receiving grant 1TL1TR001443-01 from the National Institutes of Health (NIH) National Center for Advancing Translational Sciences during the conduct of the study. Dr Schonberg reported receiving grant R01CA181357 from the National Cancer Institute during the conduct of the study. Dr Schoenborn reported receiving grants from National Institute on Aging (NIA) outside the submitted work. Dr Orkaby reported receiving grants from the Department of Veterans Affairs (VA) and the NIA/NIH, during the conduct of the study. Dr Lee reported receiving grants from the NIH and VA Health Services Research and Development (HSR&D) during the conduct of the study. No other disclosures were reported.

Funding/Support: This project was supported by grants TL1TR001443, R01AG047897 and R01AG057751 from the NIH, grant IIR 15-434 from the VA HSR&D, and resources from the San Francisco VA Health Care System.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References
1.
Colantonio  LD , Booth  JN  III , Bress  AP ,  et al.  2017 ACC/AHA blood pressure treatment guideline recommendations and cardiovascular risk.   J Am Coll Cardiol. 2018;72(11):1187-1197. doi:10.1016/j.jacc.2018.05.074 PubMedGoogle ScholarCrossref
2.
Bibbins-Domingo  K , Grossman  DC , Curry  SJ ,  et al; US Preventive Services Task Force.  Statin use for the primary prevention of cardiovascular disease in adults: US Preventive Services Task Force recommendation statement.   JAMA. 2016;316(19):1997-2007. doi:10.1001/jama.2016.15450 PubMedGoogle ScholarCrossref
3.
Grundy  SM , Stone  NJ , Bailey  AL ,  et al.  2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.   J Am Coll Cardiol. 2019;73(24):e285-e350. doi:10.1016/j.jacc.2018.11.003 PubMedGoogle ScholarCrossref
4.
Thompson  PD , Panza  G , Zaleski  A , Taylor  B .  Statin-associated side effects.   J Am Coll Cardiol. 2016;67(20):2395-2410. doi:10.1016/j.jacc.2016.02.071 PubMedGoogle ScholarCrossref
5.
Santos  TRA , Silveira  EA , Pereira  LV , Provin  MP , Lima  DM , Amaral  RG .  Potential drug-drug interactions in older adults: a population-based study.   Geriatr Gerontol Int. 2017;17(12):2336-2346. doi:10.1111/ggi.13070 PubMedGoogle ScholarCrossref
6.
Hanlon  JT , Perera  S , Newman  AB ,  et al; Health ABC Study.  Potential drug-drug and drug-disease interactions in well-functioning community-dwelling older adults.   J Clin Pharm Ther. 2017;42(2):228-233. doi:10.1111/jcpt.12502 PubMedGoogle ScholarCrossref
7.
US Food and Drug Administration. Drug safety communication: interactions between certain HIV or hepatitis C drugs and cholesterol-lowering statin drugs can increase the risk of muscle injury. Updated January 19, 2016. Accessed February 1, 2020. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-interactions-between-certain-hiv-or-hepatitis-c-drugs-and-cholesterol
8.
Bellosta  S , Paoletti  R , Corsini  A .  Safety of statins: focus on clinical pharmacokinetics and drug interactions.   Circulation. 2004;109(23)(suppl 1):III50-III57. doi:10.1161/01.CIR.0000131519.15067.1f PubMedGoogle Scholar
9.
Ginsberg  HN , Elam  MB , Lovato  LC ,  et al; ACCORD Study Group.  Effects of combination lipid therapy in type 2 diabetes mellitus.   N Engl J Med. 2010;362(17):1563-1574. doi:10.1056/NEJMoa1001282 PubMedGoogle ScholarCrossref
10.
Bellosta  S , Corsini  A .  Statin drug interactions and related adverse reactions: an update.   Expert Opin Drug Saf. 2018;17(1):25-37. doi:10.1080/14740338.2018.1394455 PubMedGoogle ScholarCrossref
11.
Kutner  JS , Blatchford  PJ , Taylor  DH  Jr ,  et al.  Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial.   JAMA Intern Med. 2015;175(5):691-700. doi:10.1001/jamainternmed.2015.0289 PubMedGoogle ScholarCrossref
12.
Lee  SJ , Leipzig  RM , Walter  LC .  Incorporating lag time to benefit into prevention decisions for older adults.   JAMA. 2013;310(24):2609-2610. doi:10.1001/jama.2013.282612 PubMedGoogle ScholarCrossref
13.
Chou  R , Dana  T , Blazina  I , Daeges  M , Jeanne  TL .  Statins for prevention of cardiovascular disease in adults: evidence report and systematic review for the US Preventive Services Task Force.   JAMA. 2016;316(19):2008-2024. doi:10.1001/jama.2015.15629 PubMedGoogle ScholarCrossref
14.
Taylor  F , Huffman  M , Macedo  A ,  et al. Statins for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews. Published January 31, 2013. Accessed February 7, 2020. https://www.cochrane.org/CD004816/VASC_statins-primary-prevention-cardiovascular-disease
15.
Agency for Healthcare Research and Quality. US Preventive Services Task Force Procedure Manual. Published December 2015. Accessed February 15, 2020. https://www.uspreventiveservicestaskforce.org/Home/GetFile/6/7/procedure-manual_2015/pdf
16.
Ridker  PM , Danielson  E , Fonseca  FA ,  et al; JUPITER Study Group.  Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein.   N Engl J Med. 2008;359(21):2195-2207. doi:10.1056/NEJMoa0807646 PubMedGoogle ScholarCrossref
17.
Nakamura  H , Arakawa  K , Itakura  H ,  et al; MEGA Study Group.  Primary prevention of cardiovascular disease with pravastatin in Japan (MEGA Study): a prospective randomised controlled trial.   Lancet. 2006;368(9542):1155-1163. doi:10.1016/S0140-6736(06)69472-5 PubMedGoogle ScholarCrossref
18.
Neil  H , Demicco  D , Luo  D ,  et al.  Analysis of efficacy and safety in patients aged 65–75 years at randomization: Collaborative Atorvastatin Diabetes Study (CARDS).   Diabetes Care. 2006;29(11):2378-2384. doi:10.2337/dc06-0872 PubMedGoogle ScholarCrossref
19.
Knopp  RH , d’Emden  M , Smilde  JG , Pocock  SJ .  Efficacy and safety of atorvastatin in the prevention of cardiovascular end points in subjects with type 2 diabetes: the Atorvastatin Study for Prevention of Coronary Heart Disease Endpoints in Non–Insulin-Dependent Diabetes Mellitus (ASPEN).   Diabetes Care. 2006;29(7):1478-1485. doi:10.2337/dc05-2415 PubMedGoogle ScholarCrossref
20.
Downs  JR , Clearfield  M , Weis  S ,  et al.  Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS Air Force/Texas Coronary Atherosclerosis Prevention Study.   JAMA. 1998;279(20):1615-1622. doi:10.1001/jama.279.20.1615 PubMedGoogle ScholarCrossref
21.
Yusuf  S , Bosch  J , Dagenais  G ,  et al; HOPE-3 Investigators.  Cholesterol lowering in intermediate-risk persons without cardiovascular disease.   N Engl J Med. 2016;374(21):2021-2031. doi:10.1056/NEJMoa1600176 PubMedGoogle ScholarCrossref
22.
Lee  SJ , Boscardin  WJ , Stijacic-Cenzer  I , Conell-Price  J , O’Brien  S , Walter  LC .  Time lag to benefit after screening for breast and colorectal cancer: meta-analysis of survival data from the United States, Sweden, United Kingdom, and Denmark.   BMJ. 2013;346:e8441. doi:10.1136/bmj.e8441 PubMedGoogle Scholar
23.
Tang  V , Boscardin  WJ , Stijacic-Cenzer  I , Lee  SJ .  Time to benefit for colorectal cancer screening: survival meta-analysis of flexible sigmoidoscopy trials.   BMJ. 2015;350:h1662. doi:10.1136/bmj.h1662PubMedGoogle ScholarCrossref
24.
Ye  S , Leppin  AL , Chan  AY ,  et al.  An informatics approach to implement support for shared decision making for primary prevention statin therapy.   MDM Policy Pract. 2018;3(1):2381468318777752. doi:10.1177/2381468318777752 PubMedGoogle Scholar
25.
Mann  DM , Ponieman  D , Montori  VM , Arciniega  J , McGinn  T .  The Statin Choice decision aid in primary care: a randomized trial.   Patient Educ Couns. 2010;80(1):138-140. doi:10.1016/j.pec.2009.10.008 PubMedGoogle ScholarCrossref
26.
DerSimonian  R , Laird  N .  Meta-analysis in clinical trials.   Control Clin Trials. 1986;7(3):177-188. doi:10.1016/0197-2456(86)90046-2PubMedGoogle ScholarCrossref
27.
Shepherd  J , Cobbe  SM , Ford  I ,  et al; West of Scotland Coronary Prevention Study Group.  Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia.   N Engl J Med. 1995;333(20):1301-1307. doi:10.1056/NEJM199511163332001 PubMedGoogle ScholarCrossref
28.
Sever  PS , Dahlöf  B , Poulter  NR ,  et al; ASCOT investigators.  Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial–Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial.   Lancet. 2003;361(9364):1149-1158. doi:10.1016/S0140-6736(03)12948-0 PubMedGoogle ScholarCrossref
29.
Lipsy  RJ .  The National Cholesterol Education Program Adult Treatment Panel III guidelines.   J Manag Care Pharm. 2003;9(1)(suppl):2-5. PubMedGoogle ScholarCrossref
30.
Ray  KK , Cannon  CP .  Time to benefit: an emerging concept for assessing the efficacy of statin therapy in cardiovascular disease.   Crit Pathw Cardiol. 2005;4(1):43-45. doi:10.1097/01.hpc.0000154979.98731.5d PubMedGoogle ScholarCrossref
31.
Holmes  HM , Min  LC , Yee  M ,  et al.  Rationalizing prescribing for older patients with multimorbidity: considering time to benefit.   Drugs Aging. 2013;30(9):655-666. doi:10.1007/s40266-013-0095-7 PubMedGoogle ScholarCrossref
32.
Furberg  CD , Adams  HP  Jr , Applegate  WB ,  et al; Asymptomatic Carotid Artery Progression Study (ACAPS) Research Group.  Effect of lovastatin on early carotid atherosclerosis and cardiovascular events.   Circulation. 1994;90(4):1679-1687. doi:10.1161/01.CIR.90.4.1679 PubMedGoogle ScholarCrossref
33.
Rosenson  RS , Baker  SK , Jacobson  TA , Kopecky  SL , Parker  BA ; The National Lipid Association’s Muscle Safety Expert Panel.  An assessment by the Statin Muscle Safety Task Force: 2014 update.   J Clin Lipidol. 2014;8(3)(suppl):S58-S71. doi:10.1016/j.jacl.2014.03.004 PubMedGoogle ScholarCrossref
34.
Rojas-Fernandez  CH , Goldstein  LB , Levey  AI , Taylor  BA , Bittner  V ; The National Lipid Association’s Safety Task Force.  An assessment by the Statin Cognitive Safety Task Force: 2014 update.   J Clin Lipidol. 2014;8(3)(suppl):S5-S16. doi:10.1016/j.jacl.2014.02.013 PubMedGoogle ScholarCrossref
35.
Pedro-Botet  J , Rubiés-Prat  J .  Statin-associated muscle symptoms: beware of the nocebo effect.   Lancet. 2017;389(10088):2445-2446. doi:10.1016/S0140-6736(17)31163-7 PubMedGoogle ScholarCrossref
36.
Adhyaru  BB , Jacobson  TA .  Unblinded ASCOT study results do not rule out that muscle symptoms are an adverse effect of statins.   Evid Based Med. 2017;22(6):210. doi:10.1136/ebmed-2017-110783 PubMedGoogle ScholarCrossref
37.
Cohen  JD , Brinton  EA , Ito  MK , Jacobson  TA .  Understanding Statin Use in America and Gaps in Patient Education (USAGE): an internet-based survey of 10 138 current and former statin users.   J Clin Lipidol. 2012;6(3):208-215. doi:10.1016/j.jacl.2012.03.003 PubMedGoogle ScholarCrossref
38.
Navar  AM , Peterson  ED , Li  S ,  et al.  Prevalence and management of symptoms associated with statin therapy in community practice: insights from the PALM (Patient and Provider Assessment of Lipid Management) Registry.   Circ Cardiovasc Qual Outcomes. 2018;11(3):e004249. doi:10.1161/CIRCOUTCOMES.117.004249 PubMedGoogle Scholar
39.
Jacobson  TA , Cheeley  MK , Jones  PH ,  et al.  The Statin Adverse Treatment Experience Survey: experience of patients reporting side effects of statin therapy.   J Clin Lipidol. 2019;13(3):415-424. doi:10.1016/j.jacl.2019.04.011 PubMedGoogle ScholarCrossref
40.
Bruckert  E , Hayem  G , Dejager  S , Yau  C , Bégaud  B .  Mild to moderate muscular symptoms with high-dosage statin therapy in hyperlipidemic patients—the PRIMO study.   Cardiovasc Drugs Ther. 2005;19(6):403-414. doi:10.1007/s10557-005-5686-z PubMedGoogle ScholarCrossref
41.
Mosshammer  D , Lorenz  G , Meznaric  S , Schwarz  J , Muche  R , Mörike  K .  Statin use and its association with musculoskeletal symptoms—a cross-sectional study in primary care settings.   Fam Pract. 2009;26(2):88-95. doi:10.1093/fampra/cmp006 PubMedGoogle ScholarCrossref
42.
Chaipichit  N , Krska  J , Pratipanawatr  T , Jarernsiripornkul  N .  Statin adverse effects: patients’ experiences and laboratory monitoring of muscle and liver injuries.   Int J Clin Pharm. 2015;37(2):355-364. doi:10.1007/s11096-015-0068-5 PubMedGoogle ScholarCrossref
43.
Rosenbaum  D , Dallongeville  J , Sabouret  P , Bruckert  E .  Discontinuation of statin therapy due to muscular side effects: a survey in real life.   Nutr Metab Cardiovasc Dis. 2013;23(9):871-875. doi:10.1016/j.numecd.2012.04.012 PubMedGoogle ScholarCrossref
44.
Zhang  H , Plutzky  J , Skentzos  S ,  et al.  Discontinuation of statins in routine care settings: a cohort study.   Ann Intern Med. 2013;158(7):526-534. doi:10.7326/0003-4819-158-7-201304020-00004 PubMedGoogle ScholarCrossref
45.
Newman  CBPD , Preiss  D , Tobert  JA ,  et al; American Heart Association Clinical Lipidology, Lipoprotein, Metabolism and Thrombosis Committee, a Joint Committee of the Council on Atherosclerosis, Thrombosis and Vascular Biology and Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; and Stroke Council.  Statin safety and associated adverse events: a scientific statement from the American Heart Association.   Arterioscler Thromb Vasc Biol. 2019;39(2):e38-e81. doi:10.1161/ATV.0000000000000073 PubMedGoogle ScholarCrossref
46.
Gutiérrez-Valencia  M , Izquierdo  M , Cesari  M , Casas-Herrero  Á , Inzitari  M , Martínez-Velilla  N .  The relationship between frailty and polypharmacy in older people: A systematic review.   Br J Clin Pharmacol. 2018;84(7):1432-1444. doi:10.1111/bcp.13590PubMedGoogle ScholarCrossref
47.
Herr  M , Robine  JM , Pinot  J , Arvieu  JJ , Ankri  J .  Polypharmacy and frailty: prevalence, relationship, and impact on mortality in a French sample of 2350 old people.   Pharmacoepidemiol Drug Saf. 2015;24(6):637-646. doi:10.1002/pds.3772 PubMedGoogle ScholarCrossref
48.
Tinetti  ME , Bogardus  ST  Jr , Agostini  JV .  Potential pitfalls of disease-specific guidelines for patients with multiple conditions.   N Engl J Med. 2004;351(27):2870-2874. doi:10.1056/NEJMsb042458 PubMedGoogle ScholarCrossref
49.
DuGoff  EH , Canudas-Romo  V , Buttorff  C , Leff  B , Anderson  GF .  Multiple chronic conditions and life expectancy: a life table analysis.   Med Care. 2014;52(8):688-694. doi:10.1097/MLR.0000000000000166 PubMedGoogle ScholarCrossref
50.
Shepherd  J , Blauw  GJ , Murphy  MB ,  et al; PROSPER study group. PROspective Study of Pravastatin in the Elderly at Risk.  Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial.   Lancet. 2002;360(9346):1623-1630. doi:10.1016/S0140-6736(02)11600-X PubMedGoogle ScholarCrossref
51.
Gurwitz  JH , Go  AS , Fortmann  SP .  Statins for primary prevention in older adults: uncertainty and the need for more evidence.   JAMA. 2016;316(19):1971-1972. doi:10.1001/jama.2016.15212 PubMedGoogle ScholarCrossref
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