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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, Armitage J, Baigent C, Barnes E, Blackwell L, Collins R, Davies K, Emberson J, Fulcher J, Halls H, Herrington WG, Holland L, Keech A, Kirby A, Mihaylova B, O'Connell R, Preiss D, Reith C, Simes J, Wilson K, Blazing M, Braunwald E, Lemos JD, Murphy S, Pedersen TR, Pfeffer M, White H, Wiviott S, Clearfield M, Downs JR, Gotto A, Weis S, Fellström B, Holdaas H, Jardine A, Pedersen TR, Gordon D, Davis B, Furberg C, Grimm R, Pressel S, Probstfield JL, Rahman M, Simpson L, Koren M, Dahlöf B, Gupta A, Poulter N, Sever P, Wedel H, Knopp RH, Cobbe S, Fellström B, Holdaas H, Jardine A, Schmieder R, Zannad F, Betteridge DJ, Colhoun HM, Durrington PN, Fuller J, Hitman GA, Neil A, Braunwald E, Davis B, Hawkins CM, Moyé L, Pfeffer M, Sacks F, Kjekshus J, Wedel H, Wikstrand J, Wanner C, Krane V, Franzosi MG, Latini R, Lucci D, Maggioni A, Marchioli R, Nicolis EB, Tavazzi L, Tognoni G, Bosch J, Lonn E, Yusuf S, Armitage J, Bowman L, Collins R, Keech A, Landray M, Parish S, Peto R, Sleight P, Kastelein JJ, Pedersen TR, Glynn R, Gotto A, Kastelein JJ, Koenig W, MacFadyen J, Ridker PM, Keech A, MacMahon S, Marschner I, Tonkin A, Shaw J, Simes J, White H, Serruys PW, Knatterud G, Blauw GJ, Cobbe S, Ford I, Macfarlane P, Packard C, Sattar N, Shepherd J, Trompet S, Braunwald E, Cannon CP, Murphy S, Collins R, Armitage J, Bowman L, Bulbulia R, Haynes R, Parish S, Peto R, Sleight P, Amarenco P, Welch KM, Kjekshus J, Pedersen TR, Wilhelmsen L, Barter P, Gotto A, LaRosa J, Kastelein JJ, Shepherd J, Cobbe S, Ford I, Kean S, Macfarlane P, Packard C, Roberston M, Sattar N, Shepherd J, Young R, Arashi H, Clarke R, Flather M, Goto S, Goldbourt U, Hopewell J, Hovingh GK, Kitas G, Newman C, Sabatine MS, Schwartz GG, Smeeth L, Tobert J, Varigos J, Yamamguchi J. Long-term cardiovascular risks and the impact of statin treatment on socioeconomic inequalities: a microsimulation model. Br J Gen Pract 2024; 74:BJGP.2023.0198. [PMID: 38373851 PMCID: PMC10904120 DOI: 10.3399/bjgp.2023.0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 09/19/2023] [Indexed: 02/21/2024] Open
Abstract
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.
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Affiliation(s)
- Runguo Wu
- Health Economics and Policy Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Claire Williams
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Junwen Zhou
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Iryna Schlackow
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jonathan Emberson
- Nuffield Department of Population Health and Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
| | - Christina Reith
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Anthony Keech
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - John Robson
- Clinical Effectiveness Group, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Jane Armitage
- Nuffield Department of Population Health and Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
| | - Alastair Gray
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - John Simes
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Colin Baigent
- Nuffield Department of Population Health and Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
| | - Borislava Mihaylova
- Health Economics and Policy Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London; associate professor and senior health economist, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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