Suzanne Brodney1, K D Valentine2, Karen Sepucha2, Floyd J Fowler3, Michael J Barry1. 1. Informed Medical Decisions Program, Massachusetts General Hospital, Boston. 2. Health Decisions Science Center, Massachusetts General Hospital, Boston. 3. Center for Survey Research, University of Massachusetts, Boston.
Abstract
Importance: Thresholds for initiating statin therapy should be informed by patients' preferences. Objective: To define the preference distribution for statin therapy across the spectrum of cardiovascular disease (CVD) risk after participants were informed about the benefits and harms of statin therapy. Design, Setting, and Participants: A cross-sectional survey was conducted from May 13 to June 2, 2020. Participants included 304 individuals aged 40 to 75 years drawn from a nonprobability opt-in panel who had not taken a statin or proprotein convertase subtilisin/kexin type 9 inhibitor in the past 3 years and knew the results of their total cholesterol, high-density lipoprotein cholesterol, and blood pressure measurements. Exposures: Personalized 10-year CVD risk with and without statin therapy and potential harms of statins. Main Outcomes and Measures: The primary outcome was self-reported preference for statin therapy. Results: The 304 participants had a mean (SD) age of 54.8 (9.9) years; 152 were women (50.0%), 130 (42.8%) non-White, 50 (16.6%) had a high school degree or less education, and 153 (50.8%) reported never needing help reading health materials. When asked their preference for using statin therapy after reviewing their benefit and risk information, 45% of the participants reported they would definitely or probably choose statin therapy. As the risk increased, the proportion who would choose statin therapy generally increased (from 31.1% for a risk <5% to 82.6% for a risk >50%). The minimum risk threshold had to increase to 20% before 75% of respondents in that risk group would want statin therapy. For participants with a risk greater than 10%, the desire to use statin therapy decreased as participants' health literacy, subjective numeracy, and knowledge scores increased. Conclusions and Relevance: In this study, preferences for statin therapy for primary prevention of CVD appeared to vary across the spectrum of 10-year cardiovascular risk, but they were relatively flat at intermediate levels of risk. This preference distribution suggests a broad risk range for shared decision-making.
Importance: Thresholds for initiating statin therapy should be informed by patients' preferences. Objective: To define the preference distribution for statin therapy across the spectrum of cardiovascular disease (CVD) risk after participants were informed about the benefits and harms of statin therapy. Design, Setting, and Participants: A cross-sectional survey was conducted from May 13 to June 2, 2020. Participants included 304 individuals aged 40 to 75 years drawn from a nonprobability opt-in panel who had not taken a statin or proprotein convertase subtilisin/kexin type 9 inhibitor in the past 3 years and knew the results of their total cholesterol, high-density lipoprotein cholesterol, and blood pressure measurements. Exposures: Personalized 10-year CVD risk with and without statin therapy and potential harms of statins. Main Outcomes and Measures: The primary outcome was self-reported preference for statin therapy. Results: The 304 participants had a mean (SD) age of 54.8 (9.9) years; 152 were women (50.0%), 130 (42.8%) non-White, 50 (16.6%) had a high school degree or less education, and 153 (50.8%) reported never needing help reading health materials. When asked their preference for using statin therapy after reviewing their benefit and risk information, 45% of the participants reported they would definitely or probably choose statin therapy. As the risk increased, the proportion who would choose statin therapy generally increased (from 31.1% for a risk <5% to 82.6% for a risk >50%). The minimum risk threshold had to increase to 20% before 75% of respondents in that risk group would want statin therapy. For participants with a risk greater than 10%, the desire to use statin therapy decreased as participants' health literacy, subjective numeracy, and knowledge scores increased. Conclusions and Relevance: In this study, preferences for statin therapy for primary prevention of CVD appeared to vary across the spectrum of 10-year cardiovascular risk, but they were relatively flat at intermediate levels of risk. This preference distribution suggests a broad risk range for shared decision-making.
Authors: Kirsten Bibbins-Domingo; David C Grossman; Susan J Curry; Karina W Davidson; John W Epling; Francisco A R García; Matthew W Gillman; Alex R Kemper; Alex H Krist; Ann E Kurth; C Seth Landefeld; Michael L LeFevre; Carol M Mangione; William R Phillips; Douglas K Owens; Maureen G Phipps; Michael P Pignone Journal: JAMA Date: 2016-11-15 Impact factor: 56.272
Authors: Jordan Fulcher; Rachel O'Connell; Merryn Voysey; Jonathan Emberson; Lisa Blackwell; Borislava Mihaylova; John Simes; Rory Collins; Adrienne Kirby; Helen Colhoun; Eugene Braunwald; John La Rosa; T R Pedersen; Andrew Tonkin; Barry Davis; Peter Sleight; Maria Grazia Franzosi; Colin Baigent; Anthony Keech Journal: Lancet Date: 2015-01-09 Impact factor: 79.321
Authors: Rory Collins; Christina Reith; Jonathan Emberson; Jane Armitage; Colin Baigent; Lisa Blackwell; Roger Blumenthal; John Danesh; George Davey Smith; David DeMets; Stephen Evans; Malcolm Law; Stephen MacMahon; Seth Martin; Bruce Neal; Neil Poulter; David Preiss; Paul Ridker; Ian Roberts; Anthony Rodgers; Peter Sandercock; Kenneth Schulz; Peter Sever; John Simes; Liam Smeeth; Nicholas Wald; Salim Yusuf; Richard Peto Journal: Lancet Date: 2016-09-08 Impact factor: 79.321
Authors: Yuan Zhang; Pablo Alonso Coello; Jan Brożek; Wojtek Wiercioch; Itziar Etxeandia-Ikobaltzeta; Elie A Akl; Joerg J Meerpohl; Waleed Alhazzani; Alonso Carrasco-Labra; Rebecca L Morgan; Reem A Mustafa; John J Riva; Ainsley Moore; Juan José Yepes-Nuñez; Carlos Cuello-Garcia; Zulfa AlRayees; Veena Manja; Maicon Falavigna; Ignacio Neumann; Romina Brignardello-Petersen; Nancy Santesso; Bram Rochwerg; Andrea Darzi; Maria Ximena Rojas; Yaser Adi; Claudia Bollig; Reem Waziry; Holger J Schünemann Journal: Health Qual Life Outcomes Date: 2017-05-02 Impact factor: 3.186