Meta-analysis summary table: statins and risk of non-fatal and fatal myocardial infarction and coronary heart disease (CHD) death combined—stratified by level of CHD risk. 1. fAverage persistence to treatment reported; subgroup summary using mean weighted by the number of p–y in the subgroup. Number of patients needed to treat (NNT) with a statin in primary prevention of coronary heart disease (CHD) is often misinterpreted because this single statistic averages results from heterogeneous studies. Comparing statin treated patients to those not treated with statins, the number needed to treat (NNT) for 1 year to prevent one incident MACE outcome ranged from 3950.9 patients (CAC=0) to 45.3 patients (CAC >400) (Table 1). Rosuvastatin: a review of its use in the prevention of cardiovascular disease in apparently healthy women or men with normal LDL-C levels and elevated hsCRP levels. Popular Reviews. The number needed to treat for cardiovascular disease over five years was 37 (95% confidence interval 27 to 64) for women and 33 (95% CI 24 to 57) for men. Knopp RH, d’Emden M, Smilde JG, et al. This post hoc analysis used the results of nine RCTs included in a Cochrane meta-analysis of statins for the primary prevention of CV disease, that specifically reported outcomes on fatal and non-fatal MI and CHD deaths (supplementary Table) (6). Identifier NCT00239681. aClassification in higher and lower CV risk by the presence or not of symptomatic CHD at inclusion and/or CV-risk factors as inclusion criteria; studies ordered by incidence of CHD (non-fatal and fatal MI and CHD death) event rates in control groups. Researchers and authors should avoid reporting combined results from all RCTs conducted in primary prevention and account for the CV risk in individual studies. 2010;10(6):383-400. doi: 10.2165/11204600-000000000-00000. In low risk patients the number needed to treat in order to prevent one death per year was 1000. Something is either good for you or bad for you. ; with CARDS investigators. Kummen M, Solberg OG, Storm-Larsen C, Holm K, Ragnarsson A, Trøseid M, Vestad B, Skårdal R, Yndestad A, Ueland T, Svardal A, Berge RK, Seljeflot I, Gullestad L, Karlsen TH, Aaberge L, Aukrust P, Hov JR. Sci Rep. 2020 Mar 25;10(1):5397. doi: 10.1038/s41598-020-62261-y. 2. Statin Use in Primary Prevention of Atherosclerotic Cardiovascular Disease According to 5 Major Guidelines for Sensitivity, Specificity, and Number Needed to Treat. Gauging the impact of statins using number needed to treat. Enas bases his numbers on a 2013 Cochrane review. To provide estimates of the number of individuals needed to be prescribed a statin to prevent one CHD event accounting for their level of CHD risk and for persistence to treatment. Would you like email updates of new search results? As an example, in the PROSEVA trial of patients with severe ARDS, prone positioning decreased 28-day all-cause mortality compared to supine positioning (16% vs. 32.8%) with a NNT of 6. No direct financial or in kind advantage was received from the sponsors of these studies, Astra-Zeneca and MSD France. In addition, it showed that the unadjusted NNT with a statin to prevent one CHD event inappropriately underestimates the number of patients to prescribe a statin. This site needs JavaScript to work properly. Utility of the antigen test for coronavirus disease 2019: Factors influencing the prediction of the possibility of disease transmission. Incidence rates of CHD events in control groups were calculated as the total number of CHD events divided by the number of p–y of observation in each RCT. The Number Needed to Treat. Knowledge of persistence-adjusted 5-year NNT values generates more realistic expectations of outcomes and reinforces the importance of promoting and monitoring compliance in patients at higher risk who are more likely to benefit from statins. NNT is derived from the reciprocal of the absolute difference between two treatment groups, often arising from randomised clinical trials. U The mortality benefit of statins is diminished if non-cardiovascular mortality is high. Clipboard, Search History, and several other advanced features are temporarily unavailable. Instead they claimed that 24 patients needed to be treated for 1 year to prevent one MI and that 42 patients needed to be treated for 1 year to prevent one stroke. The NNT Group calculates the number needed to harm (NNH) as well. The NNT tells us how many people need to be treated with a medicine in order for one person to gain any benefit from that medicine; the smaller the NNT, the better. Based on I2 statistics, RR were homogeneous within but not between the two categories. For the restricted "hard" end point of myocardial infarction, stroke, or death, the 5-year NNT was 29 (95% CI, 19 to 56). Five-year NNTs were calculated separately for each of the nine RCTs. He based his analysis of statins on a little-known but useful statistic, the number needed to treat (or NNT). For full access to this pdf, sign in to an existing account, or purchase an annual subscription. This was a departure from the Cochrane review with the consequence that it reduced the number of eligible RCTs entered in our analysis making the results not directly comparable to those published (1, 6). This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (, Interventions on health care providers to improve seasonal influenza vaccination rates among patients: a systematic review and meta-analysis of the evidence since 2000, Nudging health care workers towards a flu shot: reminders are accepted but not necessarily effective. Am J Cardiol. Background: Colhoun HM, Betteridge DJ, Durrington PN, et al. The number needed to treat (NNT) to prevent one clinical event is a commonly used metric of treatment benefit that combines aspects of both absolute risk and relative treatment effects and thus can be helpful for the translation of clinical trial data into practice. Firstly, in absolute numbers, our results estimate that 1 out of 146 lower risk individuals (1 out of 53 of higher risk patients), who are prescribed a statin for primary prevention, experiences a CHD benefit over 5 years while no benefit is to be expected in the other 145 (52 in higher risk individuals). In sensitivity analyses addressing the theoretical utility of alternative agents, 5-year NNT values of 38 and 57 were estimated for statin regimens that deliver 75% and 50% of the relative benefit observed in JUPITER, respectively. For permissions, please e-mail: journals.permissions@oup.com. Am J Cardiol. Statins in Persons at Low Risk of Cardiovascular Disease: No statistically significant mortality benefit (11/2017). Epub 2014 Apr 9. ; with the JUPITER study group. Balancing this kind of harm against the benefits expected in individuals at low CV risk may lead to reconsider statin use and put more emphasis on lifestyle management instead. 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