Primary Prevention With Statin Therapy in the Elderly
Notice bibliographique
Résumé
T he use of statin therapy for secondary prevention is established in all age groups. 1 However, in primary prevention, current cardiovascular guidelines in the United States and Canada describe the role for statin therapy in the elderly as uncertain.To examine this question, we performed a meta-analysis of age-specific outcome data from 2 recent primary prevention statin trials, JUPITER (Justification for Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin) 2 and HOPE-3 (Heart Outcomes Prevention Evaluation). 3We combined new subgroup data from these contemporary trials using a fixed-effect meta-analysis with inverse variance weighting of the log hazard ratios by age group (<65, 65-<70, and ≥70 years) using the meta package in R (R version 3.2.3).The pooled treatment effect within each subgroup was estimated, as was the between-subgroup heterogeneity statistic, Q.The JUPITER trial, published in 2008, evaluated rosuvastatin 20 mg daily among 17 802 men and women free of cardiovascular disease with low-density lipoprotein cholesterol levels <130 mg/dL and high-sensitivity C-reactive protein levels >2 mg/L. 2 For the end point of hard atherosclerotic cardiovascular events (nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death), the JUPITER trial overall reported a 47% reduction in risk (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.40-0.69;P<0.0001), as well as a 20% reduction in all-cause mortality (HR, 0.80; 95% CI, 0.67-0.97;P=0.02).As shown in the Figure (top), for the 5695 JUPITER participants ≥70 years of age, a comparable 39% reduction in risk was found for this combined cardiovascular end point (HR, 0.61; 95% CI, 0.43-0.86;P=0.004); a nonsignificant 20% reduction in all-cause mortality in this age strata (HR, 0.80; 95% CI, 0.62-1.0;P=0.09) was previously reported. 4These elderly participants, representing 32% of the total JUPITER population, suffered 55% of all the hard atherosclerotic cardiovascular events occurring in the trial.In JUPITER, effects were consistent across age groups, and a formal test for heterogeneity was nonsignificant.Rates of drug withdrawal in the rosuvastatin groups were 14.3%, 17.0%, and 21.6% among those <65, 65 to <70, and ≥70 years of age, respectively.The HOPE-3 trial, published in 2016, evaluated rosuvastatin 10 mg daily among 12 705 men and women free of cardiovascular disease who were at intermediate risk. 3For the identical end point of hard atherosclerotic cardiovascular events, the HOPE-3 trial overall reported a 24% reduction in risk (HR, 0.76; 95% CI, 0.64-0.91;P=0.002) and a 7% nonsignificant reduction in all-cause mortality (HR, 0.93; 95% CI, 0.80-1.08;P=0.32).As also shown in the Figure (top), for the 3086 HOPE-3 participants ≥70 years of age, a comparable nonsignificant 17% reduction in risk was found for the combined cardiovascular end point (HR, 0.83; 95% CI, 0.64-1.07;P=0.16), as well as a comparable nonsignificant 9% reduction in all-cause mortality (HR, 0.91; 95% CI, 0.73-1.13;P=0.38).In HOPE-3, those ≥70 years of age represented 24% of the total trial population yet suffered 43% of all the hard atherosclerotic cardiovascular events.
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 distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| 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 | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 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 tête enseignante, 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 ».