SynthesisDrugs & aging2020

Association between Statins Prescribed for Primary and Secondary Prevention and Major Adverse Cardiac Events among Older Adults with Frailty: A Systematic Review.

Matthew Hale, Hadar Zaman, David Mehdizadeh, Oliver Todd, Harriet Callaghan, Chris P Gale, Andrew Clegg

Abstract readSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Drugs & aging, 2020. The graph read 3 numbers from its abstract, feeding 1 cell of the map, but none could be read as for or against, so it casts no vote. It also reports 2 associations that do not count as treatment evidence, such as HR 0.58 (0.37 to 0.93) for all-cause mortality. Cited by 3 papers.

3numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
0.2field-weighted citation impact, top 45% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

Read, but not usablea number the graph found but could not read as for or against

All-cause mortalityan association or prognostic statement, not a treatment comparison · ascvdfeeds one cell of the map
HR 0.810.61 to 1.08
Among studies evaluating the association between statins for primary and secondary prevention and mortality, one study found statins were associated with reduced mortality (hazard ratio [HR] 0.58, 95% confidence interval [CI] 0.37-0.93), while another study found they were not (HR 0.81, 95% CI 0.61-1.08).
All-cause mortalityan association or prognostic statement, not a treatment comparison · ascvdfeeds one cell of the map
HR 0.580.37 to 0.93
Among studies evaluating the association between statins for primary and secondary prevention and mortality, one study found statins were associated with reduced mortality (hazard ratio [HR] 0.58, 95% confidence interval [CI] 0.37-0.93), while another study found they were not (HR 0.81, 95% CI 0.61-1.08).
All-cause mortalityan association or prognostic statement, not a treatment comparison · ascvdfeeds one cell of the map
HR 0.280.21 to 0.39
Furthermore, one study of statins used for secondary prevention found they were associated with reduced mortality (HR 0.28, 95% CI 0.21-0.39).

clause the extractor read what became the number

2 · Its place on the map

Where it lands on the map

Rows are treatments, columns are outcomes. The coloured squares are the cells this paper feeds, coloured by the vote it casts there. Click one to jump to what this paper adds to it.

supports the treatmentfavours the comparatorno clear differenceread, but no usable result
3 · What it changes

What it adds to each cell

For every cell the paper feeds: the belief in the claim with and without this paper, and this paper's estimate drawn against every other readable study in the cell. The ringed dot is this paper.

Statins×all-cause mortality

No readable resultOpen on the map →What to test next →

13 readable studies in this cell: 3 favour the treatment, 8 find no difference, 2 favour the comparator.

Belief with this paper
0.50contested · 3 families support, 2 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
1 · no effect
NCT023442907,769 enrolled · 2015
HR 0.880.70 to 1.12
HR 1.010.91 to 1.11
NCT03944512102 enrolled · 2019
RR 0.670.37 to 1.19
RR 0.990.89 to 1.11

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

4 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

5 · Its place in the literature

Who cites it

3 citing papers in PubMed, 5 citations in OpenAlex.

  1. Article
  2. Article
  3. Review
6 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

7 · Who and what money

Authors and funding

7 authors at 2 institutions in 1 country.

Matthew HaleAcademic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK. m.hale@doctors.org.uk.ORCID 0000-0003-4056-0304
Hadar ZamanSchool of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK.
David MehdizadehSchool of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK.
Oliver ToddAcademic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK.
Harriet CallaghanAcademic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK.
Chris P GaleLeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
Andrew CleggAcademic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK.
University of Leeds · GBUniversity of Bradford · GB

Funding

The Dunhill Medical Trust RTF107/0117
8 · The paper itself

Abstract

The marked sentences are the ones the graph read a number from.

backgroundStatins reduce the risk of major adverse cardiovascular events (MACE), however their clinical benefit for primary and secondary prevention among older adults with frailty is uncertain. This systematic review investigates whether statins prescribed for primary and secondary prevention are associated with reduced MACE among adults aged ≥ 65 years with frailty.

methodsWe conducted a systematic review of studies published between 1 January 1952 and 1 January 2019 in the MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library and International Pharmaceutical Abstracts databases. Studies that investigated the effect of statins on MACE among adults ≥ 65 years of age with a validated frailty assessment were included. Data were extracted from the papers as per a prepublished protocol, PROSPERO: CRD42019127486. Risk of bias was assessed using the Cochrane Risk of Bias in Non-Randomised Studies of Interventions tool.

resultsSix cohort studies fulfilled the inclusion criteria; there were no randomised clinical trials. Among studies evaluating the association between statins for primary and secondary prevention and mortality, one study found statins were associated with reduced mortality (hazard ratio [HR] 0.58, 95% confidence interval [CI] 0.37-0.93), while another study found they were not (HR 0.81, 95% CI 0.61-1.08). Furthermore, one study of statins used for secondary prevention found they were associated with reduced mortality (HR 0.28, 95% CI 0.21-0.39). No studies investigated the effect of statins for primary prevention or the effect of statins on the frequency of MACE.

conclusionThis review identified only observational evidence that among older people with frailty, statins are associated with reduced mortality when prescribed for secondary prevention, and an absence of evidence evaluating statin therapy for primary prevention. Randomised trial data are needed to better inform the use of statins among older adults living with frailty.

Indexed as

FrailtyAgedAged, 80 and overCardiovascular DiseasesHumansHydroxymethylglutaryl-CoA Reductase InhibitorsObservational Studies as TopicPrimary PreventionSecondary PreventionHydroxymethylglutaryl-CoA Reductase Inhibitors

Identifiers

PMID32929609
OpenAlexW3086927704

What Socratic holds

Texttitle and abstract
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.