Evidence map›Paper›PMID 25888372›Full record

ArticleJournal of the American Heart Association2015

Implications of the US cholesterol guidelines on eligibility for statin therapy in the community: comparison of observed and predicted risks in the Framingham Heart Study Offspring Cohort.

Charlotte Andersson, Danielle Enserro, Martin G Larson, Vanessa Xanthakis, Ramachandran S Vasan

Open access · goldAbstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American Heart Association, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed, 4 pooled it
5.0field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

16 citing papers in PubMed, 4 syntheses or guidelines pooled it, 49 citations in OpenAlex.

  1. Guideline
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  4. Pooled it
  5. A tool to help patients visualize ASCVD risk and the potential impact of risk-lowering interventions.International journal of cardiology. Cardiovascular risk and prevention · 2022
    Article
  6. Assessment of Atherosclerotic Cardiovascular Disease Risk in Primary Prevention.Journal of cardiopulmonary rehabilitation and prevention · 2022
    Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 2 institutions in 2 countries.

Charlotte AnderssonFramingham Heart Study, Framingham, MA (C.A., D.E., M.G.L., V.X., R.S.V.) Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark (C.A.).
Danielle EnserroFramingham Heart Study, Framingham, MA (C.A., D.E., M.G.L., V.X., R.S.V.) Department of Mathematics and Statistics, Boston University, Boston, MA (D.E., M.G.L.).
Martin G LarsonFramingham Heart Study, Framingham, MA (C.A., D.E., M.G.L., V.X., R.S.V.) Department of Mathematics and Statistics, Boston University, Boston, MA (D.E., M.G.L.) Department of Biostatistics, Boston University School of Public Health, Boston, MA (M.G.L., R.S.V.).
Vanessa XanthakisFramingham Heart Study, Framingham, MA (C.A., D.E., M.G.L., V.X., R.S.V.) Sections of Preventive Medicine and Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA (V.X., R.S.V.) Department of Epidemiology, Boston University School of Public Health, Boston, MA (V.X.).
Ramachandran S VasanFramingham Heart Study, Framingham, MA (C.A., D.E., M.G.L., V.X., R.S.V.) Department of Biostatistics, Boston University School of Public Health, Boston, MA (M.G.L., R.S.V.) Sections of Preventive Medicine and Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA (V.X., R.S.V.).
Boston University · USGentofte Hospital · DK

Funding

THE FRAMINGHAM HEART STUDY-N01HC25195-268025195-268025195N01HC025195 · HC · TRUSTEES OF BOSTON UNIVERSITY · PI WOLF, PHILIP A · 2002 to 2006
–
NHLBI NIH HHS N01-HC-25195
6 · The paper itself

Abstract

backgroundConcerns have been raised that the 2013 atherosclerotic cardiovascular disease (ASCVD) risk estimator overpredicts risk in contemporary cohorts. Whether suboptimal calibration will lead to overtreatment with statins is unknown. We investigated the numbers of people eligible for statin treatment in the Framingham Heart Study Offspring Cohort, based on the 2013 cholesterol guidelines, and estimated the proportion that may be overtreated as a result of potential miscalibration of the ASCVD estimator. METHODS AND

resultsDuring a median follow-up of 10 years, we observed 285 ASCVD events (8.4%; comprising ischemic stroke, myocardial infarction, and coronary artery disease death) among 3396 men and 112 events (2.9%) among 3838 women. Hosmer-Lemeshow chi-square statistics were 16.3 in men (340 predicted versus 285 observed events) and 29.1 in women (166 predicted versus 112 observed events). Overprediction predominantly occurred among women in the highest risk decile and among men in the ≥7th risk deciles, for which observed ASCVD event rates were ≥7.5%. In total, 2615 participants (36%; 867 women) were eligible for statins based on the new guidelines. Of these, 171 women (20%) and 154 men (9%) were reclassified downward (as not eligible for statin therapy) using a recalibrated ASCVD estimator. In the latter group, 18 women (10.5%; 95% CI 5.9% to 15.2%) and 11 men (7.1%; 95% CI 3.0% to 11.3%) experienced ASCVD.

conclusionsThe risk estimator overpredicted ASCVD risk but did so mainly among high-risk participants who would be considered eligible for statin use anyway. Our findings may mitigate concerns regarding the potential impact of miscalibration of the ASCVD estimator in contemporary cohorts.

Indexed as

Practice Guidelines as TopicAdultAgedCardiovascular DiseasesCholesterolCoronary Artery DiseaseFemaleHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMaleMiddle AgedMyocardial InfarctionRisk AssessmentRisk FactorsStrokeUnited StatesCholesterolHydroxymethylglutaryl-CoA Reductase Inhibitorsprimary preventionrisk predictionstatin

Identifiers

PMID25888372
PMCPMC4579932
OpenAlexW1989000143

What OpenQuestion holds

Texttitle and abstract
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.