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09.05.2019 | Review Article | Ausgabe 8/2019

Journal of General Internal Medicine 8/2019

Postponement of Death by Statin Use: a Systematic Review and Meta-analysis of Randomized Clinical Trials

Zeitschrift:
Journal of General Internal Medicine > Ausgabe 8/2019
Autoren:
MD, PhD Morten Rix Hansen, MD, PhD Asbjørn Hróbjartsson, MScPharm, PhD Anton Pottegård, MD, PhD Per Damkier, MD, PhD Kasper Søltoft Larsen, MD Kenneth Grønkjær Madsen, M.Sc, PhD René dePont Christensen, MScPharm Malene Elisa Lopez Kristensen, MD, PhD Palle Mark Christensen, MD, DMSc Jesper Hallas
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s11606-019-05024-4) contains supplementary material, which is available to authorized users.

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Abstract

Background

The average postponement of the outcome (gain in time to event) has been proposed as a measure to convey the effect of preventive medications. Among its advantages over number needed to treat and relative risk reduction is a better intuitive understanding among lay persons.

Objectives

To develop a novel approach for modeling outcome postponement achieved within a trial’s duration, based on published trial data and to present a formalized meta-analysis of modeled outcome postponement for all-cause mortality in statin trials.

Methods

The outcome postponement was modeled on the basis of the hazard ratio or relative risk, the mortality rate in the placebo group and the trial’s duration. Outcome postponement was subjected to a meta-analysis. We also estimated the average outcome postponement as the area between Kaplan–Meier curves. Statin trials were identified through a systematic review.

Results

The median modeled outcome postponement was 10.0 days (interquartile range, 2.9–19.5 days). Meta-analysis of 16 trials provided a summary estimate of outcome postponement for all-cause mortality of 12.6 days, with a 95% postponement interval (PI) of 7.1–18.0. For primary, secondary, and mixed prevention trials, respectively, outcome postponements were 10.2 days (PI, 4.0–16.3), 17.4 days (PI, 6.0–28.8), and 8.5 days (PI, 1.9–15.0).

Conclusions

The modeled outcome postponement is amenable to meta-analysis and may be a useful approach for presenting the benefits of preventive interventions. Statin treatment results in a small increase of average survival within the duration of a trial.

Systematic Review Registration

The systematic review was registered in PROSPERO [CRD42016037507].

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