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Pravastatin for Primary Prevention in Older Adults: Restricted Mean Survival Time Analysis

Byline: Ariela R. Orkaby, Michael W. Rich, Ryan Sun, Eliah Lux, Eliah Lux,Dae Hyun Kim Objectives To use restricted mean survival time, which summarizes treatment effects in terms of event-free time over a fixed time period, to evaluate the benefit of pravastatin therapy for primary prevention of ca... Full description

Journal Title: Journal of the American Geriatrics Society October 2018, Vol.66(10), pp.1987-1991
Main Author: Orkaby, Ariela R.
Other Authors: Rich, Michael W. , Sun, Ryan , Lux, Eliah , Wei, Lee‐Jen , Kim, Dae Hyun
Format: Electronic Article Electronic Article
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ID: ISSN: 0002-8614 ; E-ISSN: 1532-5415 ; DOI: 10.1111/jgs.15509
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recordid: wj10.1111/jgs.15509
title: Pravastatin for Primary Prevention in Older Adults: Restricted Mean Survival Time Analysis
format: Article
creator:
  • Orkaby, Ariela R.
  • Rich, Michael W.
  • Sun, Ryan
  • Lux, Eliah
  • Wei, Lee‐Jen
  • Kim, Dae Hyun
subjects:
  • Statins
  • Prevention
  • Cardiovascular Disease
  • Survival Analysis
ispartof: Journal of the American Geriatrics Society, October 2018, Vol.66(10), pp.1987-1991
description: Byline: Ariela R. Orkaby, Michael W. Rich, Ryan Sun, Eliah Lux, Eliah Lux,Dae Hyun Kim Objectives To use restricted mean survival time, which summarizes treatment effects in terms of event-free time over a fixed time period, to evaluate the benefit of pravastatin therapy for primary prevention of cardiovascular disease in older adults. Design Secondary analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial-Lipid-Lowering Trial (ALLHAT-LLT). Setting Ambulatory setting. Participants Individuals aged 65 and older (mean aged 71, 49% female) free of cardiovascular disease (N=2,867). Intervention Pravastatin 40 mg/d (n=1,467) versus usual care (n=1,400). Measurements We estimated the difference in RMST for total and coronary heart disease (CHD)-free survival between the pravastatin and usual care groups over the 6-year trial period and used parametric survival models to estimate RMST differences projected over 10 years. Results Over 6 years, individuals treated with pravastatin lived (RMST 2,008.1 days), on average, 33.7 fewer days than those receiving usual care (RMST 2,041.8 days) (difference -33.7 days, 95% confidence interval (CI)=-67.0 to -0.5 days, p=.047). Pravastatin-treated individuals lived RMST 2,088.1 days), on average, 18.7 more days free of CHD over 6 years than those receiving usual care (RMST 2,069.4 days), but this difference was not statistically significant (difference 18.7 days, 95% CI=-10.4-47.8 days, p=.21). The 10-year projection showed that pravastatin-treated individuals would live 108.1 fewer days (95% CI=-204.5 to -14.1, p=.03) than those receiving usual care, although treated individuals would gain 77.9 days (95% CI=3.8-159.6, p=.046) of CHD-free survival. Conclusion RMST provides an intuitive and explicit way to express the effect of pravastatin therapy on CHD-free and overall survival in older adults free of cardiovascular disease. This measure allows a more personalized interpretation than hazard ratios of the benefits and risks of a medical intervention for decision-making. Article Note: These authors contributed equally to this work. CAPTION(S): Appendix S1: Restricted Mean Survival Time Analysis in R Software
language:
source:
identifier: ISSN: 0002-8614 ; E-ISSN: 1532-5415 ; DOI: 10.1111/jgs.15509
fulltext: fulltext
issn:
  • 0002-8614
  • 00028614
  • 1532-5415
  • 15325415
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creatorOrkaby, Ariela R. ; Rich, Michael W. ; Sun, Ryan ; Lux, Eliah ; Wei, Lee‐Jen ; Kim, Dae Hyun
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descriptionByline: Ariela R. Orkaby, Michael W. Rich, Ryan Sun, Eliah Lux, Eliah Lux,Dae Hyun Kim Objectives To use restricted mean survival time, which summarizes treatment effects in terms of event-free time over a fixed time period, to evaluate the benefit of pravastatin therapy for primary prevention of cardiovascular disease in older adults. Design Secondary analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial-Lipid-Lowering Trial (ALLHAT-LLT). Setting Ambulatory setting. Participants Individuals aged 65 and older (mean aged 71, 49% female) free of cardiovascular disease (N=2,867). Intervention Pravastatin 40 mg/d (n=1,467) versus usual care (n=1,400). Measurements We estimated the difference in RMST for total and coronary heart disease (CHD)-free survival between the pravastatin and usual care groups over the 6-year trial period and used parametric survival models to estimate RMST differences projected over 10 years. Results Over 6 years, individuals treated with pravastatin lived (RMST 2,008.1 days), on average, 33.7 fewer days than those receiving usual care (RMST 2,041.8 days) (difference -33.7 days, 95% confidence interval (CI)=-67.0 to -0.5 days, p=.047). Pravastatin-treated individuals lived RMST 2,088.1 days), on average, 18.7 more days free of CHD over 6 years than those receiving usual care (RMST 2,069.4 days), but this difference was not statistically significant (difference 18.7 days, 95% CI=-10.4-47.8 days, p=.21). The 10-year projection showed that pravastatin-treated individuals would live 108.1 fewer days (95% CI=-204.5 to -14.1, p=.03) than those receiving usual care, although treated individuals would gain 77.9 days (95% CI=3.8-159.6, p=.046) of CHD-free survival. Conclusion RMST provides an intuitive and explicit way to express the effect of pravastatin therapy on CHD-free and overall survival in older adults free of cardiovascular disease. This measure allows a more personalized interpretation than hazard ratios of the benefits and risks of a medical intervention for decision-making. Article Note: These authors contributed equally to this work. CAPTION(S): Appendix S1: Restricted Mean Survival Time Analysis in R Software
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