Evidence map›Paper›PMID 30277567›Full record

ReviewJournal of the American Geriatrics Society2018

Statins for Primary Prevention in Older Adults-Moving Toward Evidence-Based Decision-Making.

Sonal Singh, Susan Zieman, Alan S Go, Stephen P Fortmann, Nanette K Wenger, Jerome L Fleg, Barbara Radziszewska, Neil J Stone, Sophia Zoungas, Jerry H Gurwitz

Open access · greenAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Journal of the American Geriatrics Society, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
39citing papers in PubMed, 1 pooled it
7.1field-weighted citation impact, top 2% 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

39 citing papers in PubMed, 1 synthesis or guideline pooled it, 65 citations in OpenAlex.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors at 8 institutions in 2 countries.

Sonal SinghUniversity of Massachusetts Medical School and the Meyers Primary Care Institute, Worcester, Massachusetts.
Susan ZiemanNational Institute on Aging, Bethesda, Maryland.
Alan S GoDivision of Research, Kaiser Permanente Northern California, Oakland, California.
Stephen P FortmannKaiser Permanente Center for Health Research, Portland, Oregon.
Nanette K WengerDivision of Cardiology, Department of Medicine, Emory Women's Heart Center, Emory Heart and Vascular Center, Emory University, School of Medicine, Atlanta, Georgia.
Jerome L FlegDivision of Cardiovascular Diseases, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
Barbara RadziszewskaNational Institute on Aging, Bethesda, Maryland.
Neil J StoneDivision of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Sophia ZoungasSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Jerry H GurwitzUniversity of Massachusetts Medical School and the Meyers Primary Care Institute, Worcester, Massachusetts.
National Institute on Aging · USUniversity of Massachusetts Chan Medical School · USEmory University · USKaiser Permanente · USKaiser Permanente Center for Health Research · USNational Heart Lung and Blood Institute · USNorthwestern University · USThe George Institute for Global Health · AU

Funding

Advancing Geriatrics Infrastructure & Network Growth - Admin Supplement: Designing and Testing an Informatics Tool to Aid Prescribers in Reducing Anticholinergic Burden in Older AdultsR24AG045050 · NIA · UNIV OF MASSACHUSETTS MED SCH WORCESTER · PI GURWITZ, JERRY H · 2014 to 2017
$3.6M
NIA NIH HHS R24 AG045050
6 · The paper itself

Abstract

objectivesTo determine the efficacy and safety of statins for primary prevention of atherosclerotic cardiovascular disease (ASCVD) events in older adults, especially those aged 80 and older and with multimorbidity.

methodsThe National Institute on Aging and the National Heart, Lung and Blood Institute convened A multidisciplinary expert panel from July 31 to August 1, 2017, to review existing evidence, identify knowledge gaps, and consider whether statin safety and efficacy data in persons aged 75 and older without ASCVD are sufficient; whether existing data can inform the feasibility, design, and implementation of future statin trials in older adults; and clinical trial options and designs to address knowledge gaps. This article summarizes the presentations and discussions at that workshop.

resultsThere is insufficient evidence regarding the benefits and harms of statins in older adults, especially those with concomitant frailty, polypharmacy, comorbidities, and cognitive impairment; a lack of tools to assess ASCVD risk in those aged 80 and older; and a paucity of evidence of the effect of statins on outcomes of importance to older adults, such as statin-associated muscle symptoms, cognitive function, and incident diabetes mellitus. Prospective, traditional, placebo-controlled, randomized clinical trials (RCTs) and pragmatic RCTs seem to be suitable options to address these critical knowledge gaps. Future trials have to consider greater representation of very old adults, women, underrepresented minorities, and individuals of differing health, cognitive, socioeconomic, and educational backgrounds. Feasibility analyses from existing large healthcare networks confirm appropriate power for death and cardiovascular outcomes for future RCTs in this area.

conclusionExisting data cannot address uncertainties about the benefits and harms of statins for primary ASCVD prevention in adults aged 75 and older, especially those with comorbidities, frailty, and cognitive impairment. Evidence from 1 or more RCTs could address these important knowledge gaps to inform person-centered decision-making. J Am Geriatr Soc 66:2188-2196, 2018.

Indexed as

Decision MakingPrimary PreventionAgedAtherosclerosisCognitive DysfunctionComorbidityDiabetes MellitusEducationHumansHydroxymethylglutaryl-CoA Reductase InhibitorsHydroxymethylglutaryl-CoA Reductase Inhibitorsbenefitsolder adultsprimary preventionrandomized clinical trialrisksstatins

Identifiers

PMID30277567
PMCPMC6741349
OpenAlexW2895778623

What OpenQuestion holds

Texttitle and abstract
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.