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Number of patients needed to prescribe statins in primary cardiovascular prevention: mirage and reality

Michel Rossignol1,2, Michel Labrecque3, Michel Cauchon3

  • 1Quebec National Institute for Excellence in Health and Social Services (INESSS), Montreal, Canada.

Family Practice
|December 22, 2017
PubMed

Insights

The number of patients needing statin treatment to prevent coronary heart disease (CHD) varies significantly by individual risk. Higher risk individuals require fewer statin prescriptions for one event prevented compared to lower risk individuals.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacoeconomics
  • Clinical Epidemiology

Background:

  • Number of patients needed to treat (NNT) for statin therapy in primary prevention of coronary heart disease (CHD) is often misinterpreted.
  • A single NNT statistic can mask significant variations in treatment effects across different patient populations.

Purpose of the Study:

  • To estimate the number of individuals who need to be prescribed a statin to prevent one CHD event.
  • To account for varying levels of CHD risk and treatment persistence in NNT calculations.

Main Methods:

  • Post hoc analysis of a Cochrane review on statins for primary prevention of cardiovascular diseases.
  • Calculation of 5-year NNTs from randomized clinical trials (RCTs) for 'lower' and 'higher' CHD risk groups.
  • Adjustment of NNTs for 5-year treatment persistence (65% assumed).

Main Results:

  • Persistence-adjusted 5-year NNTs were 146 for lower CHD risk and 53 for higher CHD risk.
  • These adjusted NNTs were 25% and 15% higher than unadjusted values, respectively.
  • NNTs were nearly three times higher in lower risk versus higher risk populations.

Conclusions:

  • Individualizing CHD risk assessment is crucial for guiding statin therapy decisions in primary prevention.
  • Reporting combined NNTs from heterogeneous RCTs should be avoided to prevent misinterpretation.
  • Accurate risk stratification and realistic expectation setting are essential for effective preventive strategies and patient adherence.
Abstract

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