Long-term cardiovascular risks and the impact of statin treatment on socioeconomic inequalities: a microsimulation model.
Wu R., Williams C., Zhou J., Schlackow I., Emberson J., Reith C., Keech A., Robson J., Armitage J., Gray A., Simes J., Baigent C., Mihaylova B., CTT Collaboration secretariat CTT Collaboration trialists: A to Z trial (phase Z) AFCAPS/TEXCAPS (AirForce/Texas Coronary Atherosclerosis Prevention Study)ALERT (Assessment of Lescol in Renal Transplantation)ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial)ALLIANCE (Aggressive Lipid-Lowering Initiation Abates New Cardiac Events)ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial)ASPEN (Atorvastatin Study for the Prevention of Coronary Heart Disease Endpoints in Non-Insulin Dependent Diabetes Mellitus)AURORA (A study to evaluate the Use of Rosuvastatin in subjects On Regular haemodialysis: an Assessment of survival and cardiovascular events)CARDS (Collaborative Atorvastatin Diabetes Study)CARE (Cholesterol And Recurrent Events Study)CORONA (Controlled Rosuvastatin Multinational Trial in Heart Failure)4D (Die Deutsche Diabetes Dialyse Studie)GISSI (Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto miocardico) Heart Failure and Prevention trialsHOPE-3HPS (Heart Protection Study)IDEAL (Incremental Decrease in Endpoints through Aggressive Lipid-lowering)JUPITER (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin)LIPID (Long-term Intervention with Pravastatin in Ischaemic Disease)LIPS (Lescol Intervention Prevention Study)Post-CABG (Post-Coronary Artery Bypass Graft Study)PROSPER (Prospective Study of Pravastatin in the Elderly at Risk)PROVE-IT (Pravastatin or Atorvastatin Evaluation and Infection Therapy)SEARCH (Study of Effectiveness of Additional Reductions in Cholesterol and Homocysteine)SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol Levels)4S (Scandinavian Simvastatin Survival Study)TNT (Treating to New Targets)WOSCOPS (West of Scotland Coronary Prevention Study)Other CTT Collaboration members None.
BACKGROUND: UK cardiovascular disease (CVD) incidence and mortality have declined in recent decades but socioeconomic inequalities persist. AIM: To present a new CVD model, and project health outcomes and the impact of guideline-recommended statin treatment across quintiles of socioeconomic deprivation in the UK. DESIGN AND SETTING: A lifetime microsimulation model was developed using 117 896 participants in 16 statin trials, 501 854 UK Biobank (UKB) participants, and quality-of-life data from national health surveys. METHOD: A CVD microsimulation model was developed using risk equations for myocardial infarction, stroke, coronary revascularisation, cancer, and vascular and non-vascular death, estimated using trial data. The authors calibrated and further developed this model in the UKB cohort, including further characteristics and a diabetes risk equation, and validated the model in UKB and Whitehall II cohorts. The model was used to predict CVD incidence, life expectancy, quality-adjusted life years (QALYs), and the impact of UK guideline-recommended statin treatment across socioeconomic deprivation quintiles. RESULTS: Age, sex, socioeconomic deprivation, smoking, hypertension, diabetes, and cardiovascular events were key CVD risk determinants. Model-predicted event rates corresponded well to observed rates across participant categories. The model projected strong gradients in remaining life expectancy, with 4-5-year (5-8 QALYs) gaps between the least and most socioeconomically deprived quintiles. Guideline-recommended statin treatment was projected to increase QALYs, with larger gains in quintiles of higher deprivation. CONCLUSION: The study demonstrated the potential of guideline-recommended statin treatment to reduce socioeconomic inequalities. This CVD model is a novel resource for individualised long-term projections of health outcomes of CVD treatments.