This study included patients with psoriasis, PsA, and axSpA, which are chronic immune-mediated systemic inflammatory diseases. Chronic systemic inflammation is associated with heightened risk of CVD. |
High-sensitivity C-reactive protein (hsCRP) and, more recently, the neutrophil lymphocyte ratio (NLR) have emerged as biomarkers for predicting CV disease-associated inflammation and mortality. |
Secukinumab treatment significantly reduced hsCRP and the NLR as early as week 12 and 16 in patients with psoriasis and PsA/axSpA, respectively, compared with placebo. This reduction was sustained over 52 weeks across these indications, with higher reduction seen in the subgroup of patients with a high systemic inflammatory burden. |
Traditional CV risk factor parameters including high BMI, fasting glucose, cholesterol, and blood pressure (systolic and diastolic) remained stable for at least 1 year of secukinumab treatment in patients with psoriasis, PsA, and axSpA. |
Introduction
Methods
Study Design
Study Outcomes
Statistical Analysis
Results
Study Population
Psoriasis | PsA | axSpA | |||||||
---|---|---|---|---|---|---|---|---|---|
SEC 150 mg N = 765 | SEC 300 mg N = 3285 | PBO N = 692 | SEC 150 mg N = 907 | SEC 300 mg N = 887 | PBO N = 681 | SEC 150 mg N = 1177 | SEC 300 mg N = 76 | PBO N = 727 | |
Age (years), mean ± SD | 45.4 ± 13.54 | 44.9 ± 13.73 | 44.7 ± 12.79 | 48.8 ± 12.11 | 48.5 ± 12.58 | 49.3 ± 12.27 | 39.4 ± 11.61 | 42.1 ± 11.81 | 40.1 ± 12.32 |
Gender, n (%) | |||||||||
Female | 232 (30.3) | 1089 (33.2) | 208 (30.1) | 462 (50.9) | 453 (51.1) | 377 (55.4) | 422 (35.9) | 26 (34.2) | 248 (34.1) |
Male | 533 (69.7) | 2196 (66.8) | 484 (69.9) | 445 (49.1) | 434 (48.9) | 304 (44.6) | 755 (64.1) | 50 (65.8) | 479 (65.9) |
Race, n (%) | |||||||||
White | 558 (72.9) | 2836 (86.3) | 509 (73.6) | 805 (88.8) | 814 (91.8) | 615 (90.3) | 838 (71.2) | 59 (77.6) | 522 (71.8) |
Asian | 142 (18.6) | 237 (7.2) | 121 (17.5) | 65 (7.2) | 45 (5.1) | 38 (5.6) | 276 (23.4) | 2 (2.6) | 165 (22.7) |
Black or African American | 14 (1.8) | 40 (1.2) | 13 (1.9) | 0 (0.0) | 5 (0.6) | 5 (0.7) | 5 (0.4) | 2 (2.6) | 4 (0.6) |
American Indian or Alaska Native | 33 (4.3) | 64 (1.9) | 28 (4.0) | 11 (1.2) | 1 (0.1) | 2 (0.3) | 15 (1.3) | 6 (7.9) | 9 (1.2) |
Othersa | 18 (2.3) | 108 (3.3) | 21 (3.0) | 26 (2.8) | 22 (2.5) | 21 (3.1) | 43 (3.7) | 7 (9.2) | 27 (3.7) |
Current smoking, n (%) | |||||||||
Yes | 280 (36.6) | 1183 (36.0) | 230 (33.2) | 199 (21.9) | 183 (20.6) | 131 (19.2) | 341 (29.0) | 24 (31.6) | 228 (31.4) |
Median (Q1, Q3) | Psoriasis | PsA | axSpA | |||||||
---|---|---|---|---|---|---|---|---|---|---|
SEC 150 mg N = 765 | SEC 300 mg N = 3285 | PBO N = 692 | SEC 150 mg N = 907 | SEC 300 mg N = 887 | PBO N = 681 | SEC 150 mg N = 1177 | SEC 300 mg N = 76 | PBO N = 727 | ||
Serum fasting glucose (mmol/L) | Baseline | 5.2 (4.77, 5.72) | 5.2 (4.80, 5.70) | 5.2 (4.80, 5.70) | 5.2 (4.80, 5.60) | 5.2 (4.72, 5.70) | 5.2 (4.70, 5.70) | 5.0 (4.70, 5.30) | 4.8 (4.50, 5.30) | 4.9 (4.60, 5.30) |
Week 12 | 5.3 (4.80, 5.80) | 5.3 (4.80, 5.88) | 5.2 (4.80, 5.70) | 5.3 (4.90, 6.00) | 5.3 (4.80, 5.80) | 5.3 (4.89, 5.90) | 5.1 (4.70, 5.50) | 5.1 (4.60, 5.60) | 5.0 (4.70, 5.40) | |
Week 16 | NA | NA | NA | 5.2 (4.90, 5.80) | 5.2 (4.80, 5.70) | 5.2 (4.80, 5.70) | 5.0 (4.70, 5.40) | 5.0 (4.50, 5.38) | 5.0 (4.61, 5.40) | |
Week 24 | 5.2 (4.83, 5.80) | 5.3 (4.90, 5.80) | NA | 5.3 (4.80, 5.80) | 5.3 (4.89, 5.80) | NA | 5.0 (4.70, 5.40) | 5.1 (4.70, 5.30) | NA | |
Week 52 | 5.2 (4.80, 5.80) | 5.2 (4.88, 5.80) | NA | 5.2 (4.80, 5.80) | 5.3 (4.80, 5.80) | NA | 5.1 (4.70, 5.40) | 5.1 (4.80, 5.40) | NA | |
Systolic blood pressure (mmHg) | Baseline | 127.0 (119.00, 138.00) | 128.0 (120.00, 138.00) | 126.0 (118.00, 136.00) | 128.0 (120.00, 138.00) | 126.0 (118.00, 136.00) | 128.0 (120.00, 137.00) | 124.0 (115.00, 133.00) | 127.5 (119.50, 136.00) | 124.0 (116.00, 132.00) |
Week 12 | 125.0 (118.00, 135.00) | 127.0 (119.00, 137.00) | 125.0 (117.00, 134.00) | 127.0 (119.00, 136.00) | 125.0 (118.00, 134.00) | 126.0 (118.00, 135.00) | 123.0 (114.00, 132.00) | 125.0 (118.00, 137.00) | 123.0 (115.00, 132.00) | |
Week 16 | 125.0 (117.00, 134.00) | 127.0 (118.00, 136.00) | 125.0 (117.00, 133.00) | 128.0 (118.00, 136.00) | 125.0 (117.00, 134.00) | 126.0 (120.00, 136.00) | 123.0 (115.00, 132.00) | 126.0 (120.00, 135.00) | 124.0 (116.00, 132.00) | |
Week 24 | 125.0 (116.00, 134.00) | 127.0 (119.00, 137.00) | NA | 127.0 (120.00, 136.00) | 126.0 (118.00, 134.00) | NA | 122.0 (114.00, 131.00) | 130.0 (120.00, 141.00) | NA | |
Week 52 | 126.0 (118.00, 135.00) | 127.0 (119.00, 136.00) | NA | 126.5 (119.00, 136.00) | 126.0 (117.00, 134.00) | NA | 122.0 (113.00, 131.00) | 124.0 (118.00, 134.00) | NA | |
Diastolic blood pressure (mmHg) | Baseline | 80.0 (74.00, 86.50) | 80.0 (74.00, 86.00) | 80.0 (75.00, 86.00) | 80.0 (74.00, 86.00) | 80.0 (72.00, 85.00) | 80.0 (74.00, 86.00) | 78.0 (71.00, 84.00) | 80.0 (71.50, 85.00) | 79.0 (71.00, 84.00) |
Week 12 | 80.0 (75.00, 85.00) | 80.0 (74.00, 86.00) | 80.0 (73.00, 84.00) | 80.0 (74.00, 86.00) | 80.0 (73.00, 84.00) | 80.0 (74.00, 86.00) | 78.0 (71.00, 84.00) | 80.0 (72.00, 84.00) | 78.0 (70.00, 83.00) | |
Week 16 | 80.0 (73.00, 85.00) | 80.0 (73.00, 86.00) | 79.0 (72.00, 84.00) | 80.0 (74.00, 86.00) | 78.0 (72.00, 84.00) | 80.0 (74.00, 86.00) | 78.0 (71.00, 84.00) | 79.5 (72.00, 84.00) | 78.0 (72.00, 84.00) | |
Week 24 | 80.0 (73.00, 85.00) | 80.0 (74.00, 87.00) | NA | 80.0 (73.00, 86.00) | 80.0 (73.00, 85.00) | NA | 78.0 (71.00, 84.00) | 80.0 (74.00, 88.00) | NA | |
Week 52 | 80.0 (75.00, 85.00) | 80.0 (74.00, 86.00) | NA | 80.0 (73.00, 86.00) | 78.0 (72.00, 84.00) | NA | 77.0 (70.00, 83.00) | 79.0 (74.00, 83.00) | NA | |
Body mass index (kg/m2) | Baseline | 28.4 (24.70, 33.10) | 27.9 (24.49, 32.30) | 27.8 (24.50, 32.10) | 29.1 (25.00, 33.36) | 28.1 (24.84, 32.33) | 28.7 (25.21, 32.99) | 25.6 (22.53, 29.38) | 27.2 (24.09, 31.38) | 25.6 (22.86, 29.17) |
Week 12 | 28.7 (24.90, 33.20) | 28.3 (24.50, 33.20) | 27.8 (24.30, 32.20) | NA | NA | NA | 21.5 (21.54, 21.54) | NA | 24.7 (24.71, 24.71) | |
Week 16 | NA | 27.8 (24.59, 32.00) | 35.3 (35.30, 35.30) | 28.7 (25.06, 32.89) | 27.9 (24.94, 31.99) | 28.5 (25.26, 32.77) | 25.8 (22.70, 29.41) | 27.4 (24.44, 31.40) | 25.7 (22.86, 29.25) | |
Week 24 | 28.5 (24.90, 32.70) | 28.3 (24.50, 33.10) | NA | 29.2 (25.33, 33.52) | 28.5 (25.46, 32.75) | NA | 25.5 (22.37, 29.39) | 27.2 (24.78, 31.65) | NA | |
Week 52 | 28.6 (25.00, 32.80) | 28.0 (24.67, 32.35) | NA | 29.3 (25.29, 33.17) | 28.3 (24.61, 32.41) | NA | 25.7 (22.68, 29.36) | 27.9 (25.28, 31.41) | NA | |
Total cholesterol (mmol/L) | Baseline | 5.0 (4.25, 5.66) | 4.9 (4.32, 5.62) | 5.0 (4.34, 5.80) | 5.0 (4.34, 5.72) | 4.9 (4.33, 5.61) | 5.0 (4.44, 5.82) | 4.7 (3.98, 5.46) | 4.8 (4.06, 5.15) | 4.6 (4.03, 5.41) |
Week 12 | 5.0 (4.33, 5.79) | 4.9 (4.29, 5.70) | 5.0 (4.27, 5.70) | NA | 4.9 (4.30, 5.57) | NA | NA | NA | NA | |
Week 16 | NA | 5.0 (4.35, 5.69) | NA | 5.1 (4.39, 5.78 | 5.1 (4.37, 5.72) | 5.0 (4.40, 5.60) | 4.7 (4.07, 5.51) | 4.7 (4.23, 5.31) | 4.7 (4.00, 5.31) | |
Week 24 | 5.0 (4.35, 5.67) | 4.9 (4.27, 5.66) | NA | 5.1 (4.38, 5.84) | 4.9 (4.37, 5.71) | NA | 4.7 (4.01, 5.47) | 4.9 (4.28, 5.37) | NA | |
Week 52 | 5.1 (4.35, 5.75) | 4.9 (4.29, 5.65) | NA | 5.1 (4.37, 5.76) | 4.9 (4.35, 5.68) | NA | 4.7 (4.06, 5.46) | 4.7 (4.17, 5.32) | NA | |
HDL cholesterol (mmol/L) | Baseline | 1.2 (1.01, 1.48) | 1.3 (1.09, 1.59) | 1.2 (1.04, 1.48) | 1.4 (1.12, 1.70) | 1.4 (1.17, 1.72) | 1.4 (1.14, 1.71) | 1.4 (1.14, 1.62) | 1.3 (1.12, 1.54) | 1.4 (1.11, 1.63) |
Week 12 | 1.2 (0.98, 1.50) | 1.2 (0.98, 1.48) | 1.2 (1.03, 1.48) | NA | 1.4 (1.17, 1.74) | NA | NA | NA | NA | |
Week 16 | NA | 1.4 (1.14, 1.66) | NA | 1.4 (1.13, 1.70) | 1.4 (1.12, 1.68) | 1.4 (1.13, 1.66) | 1.4 (1.15, 1.66) | 1.3 (1.15, 1.55) | 1.4 (1.13, 1.60) | |
Week 24 | 1.2 (1.01, 1.50) | 1.2 (1.01, 1.50) | NA | 1.4 (1.14, 1.70) | 1.4 (1.18, 1.74) | NA | 1.3 (1.09, 1.59) | 1.4 (1.17, 1.55) | NA | |
Week 52 | 1.2 (1.01, 1.50) | 1.3 (1.09, 1.61) | NA | 1.4 (1.13, 1.68) | 1.4 (1.16, 1.69) | NA | 1.4 (1.16, 1.66) | 1.3 (1.11, 1.56) | NA | |
LDL cholesterol (mmol/L) | Baseline | 3.1 (2.52, 3.80) | 3.1 (2.52, 3.68) | 3.1 (2.54, 3.83) | 3.1 (2.53, 3.74) | 3.1 (2.58, 3.68) | 3.1 (2.60, 3.72) | 2.9 (2.37, 3.58) | 3.0 (2.30, 3.39) | 2.9 (2.34, 3.50) |
Week 12 | 3.2 (2.54, 3.80) | 3.1 (2.51, 3.75) | 3.1 (2.51, 3.80) | NA | 3.1 (2.51, 3.67) | NA | NA | NA | NA | |
Week 16 | NA | 3.2 (2.61, 3.77) | NA | 3.2 (2.56, 3.73) | 3.1 (2.56, 3.73) | 3.1 (2.55, 3.64) | 2.9 (2.40, 3.63) | 2.9 (2.52, 3.29) | 2.9 (2.29, 3.47) | |
Week 24 | 3.2 (2.53, 3.81) | 3.1 (2.51, 3.73) | NA | 3.2 (2.58, 3.78) | 3.1 (2.56, 3.75) | NA | 2.9 (2.35, 3.51) | 3.0 (2.49, 3.40) | NA | |
Week 52 | 3.2 (2.58, 3.79) | 3.1 (2.57, 3.76) | NA | 3.2 (2.61, 3.76) | 3.1 (2.56, 3.79) | NA | 3.0 (2.41, 3.60) | 2.8 (2.38, 3.38) | NA | |
Ratio of total cholesterol/HDL | Baseline | 4.0 (3.26, 4.94) | 3.9 (3.09, 4.95) | 4.1 (3.15, 4.93) | 3.6 (2.90, 4.44) | 3.4 (2.76, 4.28) | 3.6 (2.88, 4.31) | 3.4 (2.75, 4.17) | 3.4 (2.85, 4.37) | 3.4 (2.73, 4.19) |
Week 12 | 4.0 (3.26, 5.15) | 4.0 (3.12, 5.02) | 4.0 (3.17, 4.95) | NA | 3.3 (2.71, 4.20) | NA | NA | NA | NA | |
Week 16 | NA | NA | NA | 3.6 (2.91, 4.58) | 3.6 (2.92, 4.46) | 3.6 (2.95, 4.33) | 3.4 (2.70, 4.15) | 3.4 (2.91, 4.43) | 3.4 (2.73, 4.17) | |
Week 24 | 4.1 (3.27, 5.03) | 4.0 (3.11, 4.96) | NA | 3.7 (2.91, 4.59) | 3.4 (2.80, 4.37) | NA | 3.5 (2.83, 4.32) | 3.4 (2.89, 4.17) | NA | |
Week 52 | 4.1 (3.29, 5.15) | 4.0 (3.12, 4.83) | NA | 3.6 (2.94, 4.56) | 3.5 (2.82, 4.35) | NA | 3.3 (2.69, 4.10) | 3.4 (2.85, 4.16) | NA | |
Triglycerides (mmol/L) | Baseline | 1.4 (1.02, 2.07) | 1.3 (0.91, 1.89) | 1.5 (1.01, 2.08) | 1.3 (0.95, 1.84) | 1.3 (0.91, 1.74) | 1.3 (0.95, 1.84) | 1.1 (0.78, 1.54) | 1.0 (0.78, 1.73) | 1.1 (0.79, 1.56) |
Week 12 | 1.5 (1.06, 2.26) | 1.4 (0.99, 2.10) | 1.4 (0.96, 2.08) | NA | 1.3 (0.96, 2.02) | NA | NA | NA | NA | |
Week 16 | NA | 1.3 (0.91, 1.80) | NA | 1.4 (0.98, 2.01) | 1.3 (0.99, 1.96) | 1.3 (0.92, 1.86) | 1.1 (0.79, 1.67) | 1.1 (0.84, 1.63) | 1.1 (0.78, 1.61) | |
Week 24 | 1.5 (1.07, 2.29) | 1.4 (1.01, 2.10) | NA | 1.4 (0.97, 1.97) | 1.3 (0.99, 1.96) | NA | 1.2 (0.81, 1.67) | 1.1 (0.81, 1.89) | NA | |
Week 52 | 1.6 (1.10, 2.37) | 1.4 (0.95, 1.99) | NA | 1.4 (1.01, 2.08) | 1.4 (0.98, 1.94) | NA | 1.2 (0.81, 1.67) | 1.1 (0.84, 1.72) | NA | |
Apolipoprotein A1 (g/L) | Baseline | 1.4 (1.22, 1.60) | 1.4 (1.23, 1.60) | 1.4 (1.25, 1.59) | 1.5 (1.28, 1.72) | 1.5 (1.29, 1.65) | 1.5 (1.31, 1.74) | 1.4 (1.23, 1.59) | 1.4 (1.23, 1.50) | 1.4 (1.24, 1.63) |
Week 12 | 1.4 (1.21, 1.62) | 1.4 (1.23, 1.61) | 1.4 (1.24, 1.63) | NA | NA | NA | NA | NA | NA | |
Week 16 | NA | NA | NA | 1.5 (1.31, 1.73) | 1.5 (1.32, 1.71) | 1.5 (1.31, 1.71) | 1.4 (1.26, 1.62) | 1.4 (1.25, 1.56) | 1.4 (1.23, 1.62) | |
Week 24 | 1.4 (1.25, 1.62) | 1.4 (1.25, 1.61) | NA | 1.5 (1.30, 1.73) | 1.5 (1.33, 1.71) | NA | 1.4 (1.23, 1.58) | 1.5 (1.32, 1.64) | NA | |
Week 52 | 1.4 (1.25, 1.63) | 1.4 (1.25, 1.64) | NA | 1.5 (1.29, 1.70) | 1.5 (1.29, 1.70) | NA | 1.4 (1.27, 1.64) | 1.5 (1.28, 1.60) | NA | |
Apolipoprotein B (g/L) | Baseline | 1.0 (0.84, 1.20) | 1.0 (0.82, 1.15) | 1.0 (0.83, 1.20) | 1.0 (0.85, 1.17) | 1.0 (0.84, 1.14) | 1.0 (0.85, 1.15) | 0.9 (0.78, 1.13) | 0.9 (0.74, 1.03) | 0.9 (0.77, 1.11) |
Week 12 | 1.0 (0.82, 1.22) | 1.0 (0.82, 1.19) | 1.0 (0.81, 1.21) | NA | NA | NA | NA | NA | NA | |
Week 16 | NA | NA | NA | 1.0 (0.87, 1.20) | 1.0 (0.84, 1.19) | 1.0 (0.84, 1.17) | 0.9 (0.79, 1.13) | 0.9 (0.77, 1.03) | 0.9 (0.77, 1.09) | |
Week 24 | 1.0 (0.82, 1.19) | 1.0 (0.82, 1.18) | NA | 1.0 (0.86, 1.20) | 1.0 (0.84, 1.20) | NA | 0.9 (0.77, 1.11) | 0.9 (0.80, 1.08) | NA | |
Week 52 | 1.1 (0.87, 1.24) | 1.0 (0.84, 1.20) | NA | 1.0 (0.88, 1.22) | 1.0 (0.86, 1.18) | NA | 1.0 (0.80, 1.15) | 0.9 (0.78, 1.10) | NA |
Median change from baseline (Q1, Q3) | Psoriasis | PsA | axSpA | ||||||
---|---|---|---|---|---|---|---|---|---|
SEC | PBO N = 692 | SEC | PBO N = 681 | SEC | PBO N = 727 | ||||
150 mg N = 765 | 300 mg N = 3285 | 150 mg N = 907 | 300 mg N = 887 | 150 mg N = 1177 | 300 mg N = 76 | ||||
Overall population | |||||||||
hsCRP (mg/L) | |||||||||
Baseline | 2.6 (1.10, 5.90) | 2.3 (1.10, 4.90) | 2.5 (1.05, 5.45) | 4.2 (1.70, 9.80) | 4.6 (1.80, 10.90) | 4.4 (1.80, 9.95) | 6.2 (2.40, 14.50) | 6.8 (1.90, 12.80) | 6.0 (2.40, 14.10) |
Week 12/16a | − 0.4 (− 2.10, 0.30) P < 0.0001 | − 0.3 (− 2.00, 0.30) P < 0.0001 | − 0.1 (− 1.00, 0.80) | − 0.8 (− 5.00, 0.20) P < 0.0001 | − 1.4 (− 6.20, 0.10) P < 0.0001 | 0.0 (− 2.00, 1.80) | − 2.1 (− 8.80, 0.00) P < 0.0001 | − 2.1 (− 9.50, 0.20) P < 0.0001 | − 0.2 (− 3.00, 1.70) |
NLR | |||||||||
Baseline | 2.5 (1.86, 3.43) | 3.2 (2.49, 3.21) | 2.6 (2.01, 3.33) | 2.6 (1.94, 3.46) | 2.6 (1.95, 3.38) | 2.5 (1.93, 3.33) | 2.5 (1.88, 3.30) | 2.2 (1.82, 3.13) | 2.5 (1.93, 3.25) |
Week 12/16a | − 0.4 (− 1.00, 0.14) P < 0.0001 | − 0.7 (− 1.42, − 0.08) P < 0.0001 | − 0.1 (− 0.56, 0.38) | − 0.4 (− 1.01, 0.16) P < 0.0001 | − 0.5 (− 0.97, 0.09) P < 0.0001 | 0.0 (− 0.54, 0.49) | − 0.4 (− 0.97, 0.18) P < 0.0001 | − 0.5 (− 1.08, 0.19) P = 0.0011 | 0.0 (− 0.58, 0.50) |
High-risk patients subgroup (baseline hsCRP > 10 mg/L in PsA/axSpA and > 4 mg/L in psoriasis) | |||||||||
hsCRP (mg/L) | |||||||||
N = 272 | N = 757 | N = 229 | N = 219 | N = 244 | N = 167 | N = 420 | N = 28 | N = 262 | |
Baseline | 8.0 (5.60, 14.05) | 7.3 (5.30, 13.40) | 8.7 (5.40, 16.50) | 19.9 (14.90, 41.30) | 17.5 (13.70, 35.30) | 17.9 (12.80, 40.20) | 19.6 (13.45, 42.30) | 16.6 (11.80, 35.15) | 23.3 (13.00, 46.30) |
Week 12/16a | − 3.2 (− 8.00, − 0.80) P = 0.0001 | − 3.3 (− 8.95, − 0.90) P = 0.0002 | − 1.8 (− 5.40, 1.60) | − 14.7 (− 33.30, − 7.30) P < 0.0001 | − 13.2 (− 29.80, − 7.90) P < 0.0001 | − 4.1 (− 14.80, 4.10) | − 13.7 (− 32.20, − 7.80) P < 0.0001 | − 12.9 (− 27.60, − 8.80) P < 0.0001 | − 4.6 (− 11.90, 1.00) |
NLR | |||||||||
Baseline | 2.9 (2.16, 4.03) | 2.8 (2.13, 3.68) | 3.0 (2.30, 4.01) | 3.3 (2.60, 4.31) | 3.0 (2.43, 3.92) | 3.1 (2.21, 3.94) | 3.0 (2.23, 3.84) | 2.7 (2.08, 3.96) | 2.9 (2.18, 3.69) |
Week 12/16a | − 0.6 (− 1.51, − 0.04) P < 0.0001 | − 0.5 (− 1.12, − 0.01) P < 0.0001 | − 0.1 (− 0.71, 0.35) | − 0.9 (− 1.63, − 0.19) P < 0.0001 | − 0.8 (− 1.38, − 0.07) P < 0.0001 | − 0.2 (− 0.66, 0.55) | − 0.7 (− 1.28, − 0.08) P < 0.0001 | − 0.6 (− 1.54, − 0.02) P = 0.0027 | − 0.1 (− 0.70, 0.61) |