Reply to Letter From Rajput—Mortality Reporting for Statin Use in Primary Prevention

Abstract

The authors have read with great interest the detailed correspondence from Dr Rajput regarding the table in our recent viewpoint article on the prescription of statin therapy in primary prevention.1Rajput M.L. Incomplete and misleading table used for reappraisal of statin therapy.Can J Cardiol. 2016; 32: 1261.e7Abstract Full Text Full Text PDF Scopus (1) Google Scholar The authors are of course delighted to clarify as suggested that the event rates mentioned in the table of our previous article refer to all-cause mortality.2Bleakley C. Pumb R. Harbinson M. McVeigh G.E. A reappraisal of the safety and cost-effectiveness of statin therapy in primary prevention.Can J Cardiol. 2015; 31: 1411-1414Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar It is also agreed that it is not made clear that the additional column on numbers needed to treat is calculated in relation to the follow-up period of each study and for that study's primary outcome measure. It is also, as suggested, not clear enough in our table that all-cause mortality outcomes, which the majority of the table reports, and primary outcomes, which the number needed to treat reflects, are different. A corrected table is provided (Table 1).Table 1Data for participants without clinically manifested coronary heart diseaseAdapted from Ray et al.3Ray K.K. Seshasai S.R. Erqou S. et al.Statins and all-cause mortality in high-risk primary prevention: a meta-analysis of 11 randomized controlled trials involving 65,229 participants.Arch Intern Med. 2010; 170: 1024-1031Crossref PubMed Scopus (391) Google Scholar with permission from the American Medical Association. Copyright © 2010 American Medical Association. All rights reserved.TrialNMean age (y)% maleIntervention% diabeticMean follow-up (y)All-cause mortality event rates/1000 person-years (statin arm)All cause mortality event rates/1000 person-years (placebo arm)Number needed to treat (over the respective follow-up period of each study for the respective primary end point of each study)JUPITER (2008)17,8026662Rosuvastatin 20 mg daily02.21012.595MEGA (2006)78325832Pravastatin 40 mg daily214.62.43.6119ASPEN (2006)19056162Atorvastatin 10 mg daily1004.310.810.2–HYRIM (2005)65,2296265Fluvastatin 40 mg daily193.710.711.4–PREVEND IT (2004)8645165Pravastatin 40 mg daily2.53.87.77.255CARDS (2004)28386268Atorvastatin 10 mg daily100410.714.532ASCOT (2003)87156381Atorvastatin 10 mg daily253.310.912.432ALLHAT (2002)88806651Pravastatin 40 mg daily354.824.324.391PROSPER (2002)32397542Pravastatin 40 mg daily123.227.22621AFCAPS/TexCAPS IT (1998)66055885Lovastatin 20-40 mg daily65.24.64.424WOSCOPS (1995)598155100Pravastatin 40 mg daily14.96.48.244AFCAPS/TexCAPS IT, Air Force/Texas Coronary Atherosclerosis Prevention Study; ALLHAT, Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial; ASCOT, Anglo-Scandinavian Cardiac Outcomes Trial; ASPEN, Atorvastatin Study for Prevention of Coronary Heart Disease Endpoints in Non-Insulin-Dependent Diabetes Mellitus; CARDS, Collaborative Atorvastatin Diabetes Study; HYRIM, Hypertension High Risk Management; JUPITER, Justification for the Use of Statin in Prevention: An Intervention Trial Evaluating Rosuvastatin; MEGA, Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese; PREVEND IT, Prevention of Renal and Vascular Endstage Disease Intervention Trial; PROSPER, Prospective Study of Pravastatin in the Elderly at Risk; WOSCOPS, West of Scotland Coronary Prevention Study. Open table in a new tab AFCAPS/TexCAPS IT, Air Force/Texas Coronary Atherosclerosis Prevention Study; ALLHAT, Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial; ASCOT, Anglo-Scandinavian Cardiac Outcomes Trial; ASPEN, Atorvastatin Study for Prevention of Coronary Heart Disease Endpoints in Non-Insulin-Dependent Diabetes Mellitus; CARDS, Collaborative Atorvastatin Diabetes Study; HYRIM, Hypertension High Risk Management; JUPITER, Justification for the Use of Statin in Prevention: An Intervention Trial Evaluating Rosuvastatin; MEGA, Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese; PREVEND IT, Prevention of Renal and Vascular Endstage Disease Intervention Trial; PROSPER, Prospective Study of Pravastatin in the Elderly at Risk; WOSCOPS, West of Scotland Coronary Prevention Study. The author has no conflicts of interest to disclose. A Reappraisal of the Safety and Cost-Effectiveness of Statin Therapy in Primary PreventionCanadian Journal of CardiologyVol. 31Issue 12PreviewStatins are among the most investigated drugs of all time. There is now a wealth of evidence supporting their use in the primary and secondary prevention arenas. The reduction in event recurrence has since been demonstrated across all levels of risk and in elderly patients. As a result, it is now accepted practice for statins to be prescribed universally in secondary prevention unless contraindicated. The extension of this policy into the primary prevention setting is more problematic, with moral and financial issues arising from the long-term treatment of many young apparently healthy individuals. Full-Text PDF Incomplete and Misleading Table Used for Reappraisal of Statin TherapyCanadian Journal of CardiologyVol. 32Issue 10PreviewWhen reading the statin therapy viewpoint by Bleakley et al.1 in the December 2015 issue of the Canadian Journal of Cardiology, I noticed a couple of significant errors in Table 1. Full-Text PDF