Statins and the risk of idiopathic venous thromboembolism
Notice bibliographique
Résumé
The matched case–control study by Yang, Jick and Jick was designed ‘to evaluate the association between current statin use and the risk of idiopathic venous thromboembolism (VTE)’[1]. We feel obligated to address three points that challenge their most tenuous conclusion that ‘current statin use was not associated with a reduced risk of idiopathic VTE’. As shown in the Figure, the authors identified a total of 72 cases with idiopathic VTE, of whom only 37 (51%) had records confirming objectively proven VTE. The remaining 35 cases (49%) (dashed boxes) had ‘probable VTE’, of whom 22 individuals (30%) had no manual records available for review, but an ‘anticoagulant-supported diagnosis’ of idiopathic VTE [1]. Therefore, between 30% and 49% of the 72 cases may have been incorrectly classified as having VTE. Such nondifferential misclassification of disease status always introduces a bias toward the null value for the effect size [2]. Second, out of 72 cases with idiopathic VTE, only three (4.2%) were current or recent statin users, while 18 out of 432 controls (4.2%) were statin users, as listed in Table 2 of their paper [1]. Considering that only 4.2% of cases were exposed to statins, one cannot address the primary study question in a valid manner. At a rate of statin exposure of only 4.2% among the 432 controls, with a 6 : 1 matching of controls to cases, the statistical power was only 8% to demonstrate a statistically significant odds ratio (OR) of 0.5, for example. To show an OR of 0.9, as in their study [1], the corresponding power level was only 5%. Suppose that 8.4% of controls received statins, and there was a 50% reduction in the risk of VTE with statin use (i.e. OR 0.5). Using a case–control study with a 6 : 1 matching ratio, and with α= 0.05 and a conventional power setting of 80%, 373 cases and 2238 controls would be required, a sample size more than five times larger than that used in the current study [1]. Unfortunately, nowhere in their paper do the authors reveal a sample size estimation, or the fact that their study was severely underpowered. Finally, we previously published a retrospective cohort study of statin use and the risk of deep vein thrombosis (DVT) among 125 862 adults aged ≥ 65 years [3]. This study was initiated without knowledge of the findings of the Heart and Estrogen/progestin Replacement Study (HERS) [4]. After adjusting for age, sex, prior hospitalization, newly diagnosed cancer, or prescribed ASA, warfarin or oestrogen, we observed that statin users had an adjusted hazard ratio of 0.78 (95% confidence interval 0.69, 0.87) for DVT relative to those prescribed neutral thyroid replacement agents. This was evident in women but not men [3], supporting the findings of the HERS investigators [4]. Valid evidence is needed to address the hypothesis that statins may be protective against VTE [5]. Yang and colleagues may have arrived at a spuriously negative conclusion based on a suboptimal study design.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».