Evidence map›Paper›PMID 28687710›Full record

ArticleCirculation2017

Evaluating the Impact and Cost-Effectiveness of Statin Use Guidelines for Primary Prevention of Coronary Heart Disease and Stroke.

David J Heller, Pamela G Coxson, Joanne Penko, Mark J Pletcher, Lee Goldman, Michelle C Odden, Dhruv S Kazi, Kirsten Bibbins-Domingo

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Circulation, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 50 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
50citing papers in PubMed, 3 pooled it
13.1field-weighted citation impact, top 1% 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

50 citing papers in PubMed, 3 syntheses or guidelines pooled it, 109 citations in OpenAlex.

  1. Pooled it
  2. Guideline
  3. Pooled it
  4. Trial
  5. Article
  6. Review
  7. Article
  8. Article
  9. Review
  10. Statin Use Among Women and Men Following Coronary Artery Bypass Surgery.Journal of the American Heart Association · 2025
    Article
  11. Article
  12. Article
  13. Article
  14. Article
  15. Article
  16. Article
  17. Article
  18. Review
  19. Article
  20. Dyslipidemia: A Narrative Review on Pharmacotherapy.Pharmaceuticals (Basel, Switzerland) · 2024
    Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 1 country.

David J HellerFrom Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY (D.J.H.); Departments of Medicine (P.G.C., J.P., M.J.P., D.S.K., K.B.-D.) and Epidemiology and Biostatistics (M.J.P., K.B.-D.), University of California, San Francisco; Faculty of Health Sciences and Medicine, Columbia University, New York, NY (L.G.); and School of Biological and Population Health Sciences, Oregon State University, Corvallis (M.C.O.).
Pamela G CoxsonFrom Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY (D.J.H.); Departments of Medicine (P.G.C., J.P., M.J.P., D.S.K., K.B.-D.) and Epidemiology and Biostatistics (M.J.P., K.B.-D.), University of California, San Francisco; Faculty of Health Sciences and Medicine, Columbia University, New York, NY (L.G.); and School of Biological and Population Health Sciences, Oregon State University, Corvallis (M.C.O.).
Joanne PenkoFrom Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY (D.J.H.); Departments of Medicine (P.G.C., J.P., M.J.P., D.S.K., K.B.-D.) and Epidemiology and Biostatistics (M.J.P., K.B.-D.), University of California, San Francisco; Faculty of Health Sciences and Medicine, Columbia University, New York, NY (L.G.); and School of Biological and Population Health Sciences, Oregon State University, Corvallis (M.C.O.).
Mark J PletcherFrom Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY (D.J.H.); Departments of Medicine (P.G.C., J.P., M.J.P., D.S.K., K.B.-D.) and Epidemiology and Biostatistics (M.J.P., K.B.-D.), University of California, San Francisco; Faculty of Health Sciences and Medicine, Columbia University, New York, NY (L.G.); and School of Biological and Population Health Sciences, Oregon State University, Corvallis (M.C.O.).
Lee GoldmanFrom Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY (D.J.H.); Departments of Medicine (P.G.C., J.P., M.J.P., D.S.K., K.B.-D.) and Epidemiology and Biostatistics (M.J.P., K.B.-D.), University of California, San Francisco; Faculty of Health Sciences and Medicine, Columbia University, New York, NY (L.G.); and School of Biological and Population Health Sciences, Oregon State University, Corvallis (M.C.O.).
Michelle C OddenFrom Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY (D.J.H.); Departments of Medicine (P.G.C., J.P., M.J.P., D.S.K., K.B.-D.) and Epidemiology and Biostatistics (M.J.P., K.B.-D.), University of California, San Francisco; Faculty of Health Sciences and Medicine, Columbia University, New York, NY (L.G.); and School of Biological and Population Health Sciences, Oregon State University, Corvallis (M.C.O.).
Dhruv S KaziFrom Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY (D.J.H.); Departments of Medicine (P.G.C., J.P., M.J.P., D.S.K., K.B.-D.) and Epidemiology and Biostatistics (M.J.P., K.B.-D.), University of California, San Francisco; Faculty of Health Sciences and Medicine, Columbia University, New York, NY (L.G.); and School of Biological and Population Health Sciences, Oregon State University, Corvallis (M.C.O.).
Kirsten Bibbins-DomingoFrom Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY (D.J.H.); Departments of Medicine (P.G.C., J.P., M.J.P., D.S.K., K.B.-D.) and Epidemiology and Biostatistics (M.J.P., K.B.-D.), University of California, San Francisco; Faculty of Health Sciences and Medicine, Columbia University, New York, NY (L.G.); and School of Biological and Population Health Sciences, Oregon State University, Corvallis (M.C.O.). bibbinsk@medicine.ucsf.edu.
Columbia University · USIcahn School of Medicine at Mount Sinai · USUniversity of California, San Francisco · US

Funding

Potential future benefits of cardiovascular risk factor control in today’s young adultsR01HL107475 · NHLBI · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI MORAN, ANDREW EDWARD · 2011 to 2018
$2.5M
Hypertension Management in Minority and Low-income PopulationsK24DK103992 · NIDDK · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI BIBBINS-DOMINGO, KIRSTEN · 2014 to 2018
$917k
Modeling Optimal Strategies to Prevent Cardiovascular Events in Older AdultsK01AG039387 · NIA · OREGON STATE UNIVERSITY · PI ODDEN, MICHELLE CHRISTINA · 2012 to 2016
$688k
NHLBI NIH HHS R01 HL107475NIA NIH HHS K01 AG039387NIDDK NIH HHS K24 DK103992
6 · The paper itself

Abstract

backgroundStatins are effective in the primary prevention of atherosclerotic cardiovascular disease. The 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline expands recommended statin use, but its cost-effectiveness has not been compared with other guidelines.

methodsWe used the Cardiovascular Disease Policy Model to estimate the cost-effectiveness of the ACC/AHA guideline relative to current use, Adult Treatment Panel III guidelines, and universal statin use in all men 45 to 74 years of age and women 55 to 74 years of age over a 10-year horizon from 2016 to 2025. Sensitivity analyses varied costs, risks, and benefits. Main outcomes were incremental cost-effectiveness ratios and numbers needed to treat for 10 years per quality-adjusted life-year gained.

resultsEach approach produces substantial benefits and net cost savings relative to the status quo. Full adherence to the Adult Treatment Panel III guideline would result in 8.8 million more statin users than the status quo, at a number needed to treat for 10 years per quality-adjusted life-year gained of 35. The ACC/AHA guideline would potentially result in up to 12.3 million more statin users than the Adult Treatment Panel III guideline, with a marginal number needed to treat for 10 years per quality-adjusted life-year gained of 68. Moderate-intensity statin use in all men 45 to 74 years of age and women 55 to 74 years of age would result in 28.9 million more statin users than the ACC/AHA guideline, with a marginal number needed to treat for 10 years per quality-adjusted life-year gained of 108. In all cases, benefits would be greater in men than women. Results vary moderately with different risk thresholds for instituting statins and statin toxicity estimates but depend greatly on the disutility caused by daily medication use (pill burden).

conclusionsAt a population level, the ACC/AHA guideline for expanded statin use for primary prevention is projected to treat more people, to save more lives, and to cost less compared with Adult Treatment Panel III in both men and women. Whether individuals benefit from long-term statin use for primary prevention depends more on the disutility associated with pill burden than their degree of cardiovascular risk.

Indexed as

Cost-Benefit AnalysisAdultAgedAged, 80 and overAmerican Heart AssociationCholesterol, LDLCoronary DiseaseFemaleHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMaleMiddle AgedMonte Carlo MethodPractice Guidelines as TopicQuality of LifeStrokeCholesterol, LDLHydroxymethylglutaryl-CoA Reductase Inhibitorscoronary diseasecost-benefit analysishydroxymethylglutaryl-CoA reductase inhibitorsprimary prevention

Identifiers

PMID28687710
PMCPMC5605438
OpenAlexW2729683435

What OpenQuestion holds

Textmetadata
LicenceTDM
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.