Optimal Risk Thresholds for Prescribing Statins As Primary Prevention of Cardiovascular Disease in Iranian General Population: a Benefit-Harm Modelling Study

Davood Khalili,Hassan Saadati,Hamid Reza Baradaran,Farzad Hadaegh,Ewout W. Steyerberg,Mark Woodward,Goodarz Danaei

BMC CARDIOVASCULAR DISORDERS（2024）

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Abstract

The use of statins for the primary prevention of cardiovascular diseases (CVD) is associated with various beneficial outcomes, alongside certain undesirable effects. This study aims to determine optimal risk thresholds above which statin therapy yields a net benefit, considering both the positive effects and potential adverse effects, as well as their probabilities and patient preferences. Quantitative benefit-harm balance modeling was applied to the Iranian general population aged 40 to 75 years with no history of CVD. The analysis utilized data from prior studies, including statin effect estimates for different outcomes from a meta-analysis, patient preferences obtained from an Iranian survey, and baseline incidence rates of adverse outcomes sourced from the Global Burden of Disease study for Iran. Outcomes were defined as angina, myocardial infarction, fatal coronary heart disease, fatal or non-fatal stroke, and heart failure. Benefit-harm balance indices were calculated for various combinations of age, sex, and 10-year CVD risk. Statin therapy was found to be advantageous at a lower 10-year CVD risk threshold in men (18–23

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Key words

Primary prevention,Cardiovascular diseases,Statin,Benefit–harm,Risk threshold

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【要点】：本研究通过效益-危害平衡模型确定了伊朗一般人群中，使用他汀类药物作为心血管疾病一级预防的最优风险阈值，权衡了正面效果与潜在不良反应及其概率和患者偏好。

【方法】：研究采用定量效益-危害平衡模型，对伊朗40至75岁无心血管疾病史的一般人群进行分析。

【实验】：分析利用了之前研究的数据，包括来自荟萃分析的他汀类药物对不同结果的影响估计、来自伊朗调查的患者偏好以及伊朗全球疾病负担研究中不良结局的基线发生率。研究了不同年龄、性别和10年心血管疾病风险组合下的效益-危害平衡指数。发现男性在10年心血管疾病风险较低阈值（18-23%）时，使用他汀类药物具有优势。

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