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Effect of statins #3

Open chjackson opened 8 years ago

chjackson commented 8 years ago

Work out how to adjust the effect of statins on events and / or mortality on top of cholesterol lowering, to accord with the trial data.

chjackson commented 8 years ago

Chris to consider this week, and make a suggestion to the team.

JDWoodcock commented 8 years ago

a. – compared with meta-analysis we are coming up with smaller effects on cardiovascular events and much smaller effects on mortality. We need to find a way to directly model from the reduction in cholesterol to mortality rates. E.g 11% reduction per 1 mmol in all cause mortality vs our finding of 0.4% c. We also discussed that change in cholesterol through Q-Risk was not adequately modelling the expected benefit. E.g. a 1mmol reduction in cholesterol should map to about a 20% reduction in CVD risk (? See meta-analysis from cholesterol trialists collaboration) d. Mechanism for mortality reduction from statins not well understood BUT is consistent in RCT e. Suggest model a drop off rate for statin (separate to initial adherence), the drop off rate should be greatest at start and then decline (Simon did suggest a data source - ? BMJ paper on media reporting)

JDWoodcock commented 8 years ago

Suggest 3 stage process 1) scale up effect of LDL reduction on qrisk such that 1mmol reduction reduces qrisk by 20% for those with statins (compared with about 12% at the moment) 2) test with new instant mortality rate to see how this affects the LE benefits 3) if still too small an effect on mortality then introduce an extra effect on all-cause (including CVD and other) mortality

chjackson commented 8 years ago

Applying an 18% risk reduction for men and 12% for women, on top of the effect of decreasing LDL and increasing HDL, achieves the event rate reductions from the trials. Still gives only 1% reductions in 5 year and 10 year mortality.