Effectiveness and efficiency of different guidelines on statin treatment for preventing deaths from coronary heart disease: modelling study.

Abstract:

OBJECTIVE:To examine the potential effectiveness and efficiency of different guidelines for statin treatment to reduce deaths from coronary heart disease in the Canadian population. DESIGN:Modelled outcomes of screening and treatment recommendations of six national or international guidelines--from Canada, Australia, New Zealand, the United States, joint British societies, and European societies. SETTING:Canada. DATA SOURCES:Details for 6760 men and women aged 20-74 years from the Canadian Heart Health Survey (weighted sample of 12,300,000 people) that included physical measurements including a lipid profile. MAIN OUTCOME MEASURES:The number of people recommended for treatment with statins, the potential number of deaths from coronary heart disease avoided, and the number needed to treat to avoid one coronary heart disease death with five years of statin treatment if the recommendations from each guideline were fully implemented. RESULTS:When applied to the Canadian population, the Australian and British guidelines were the most effective, potentially avoiding the most deaths over five years (> 15,000 deaths). The New Zealand guideline was the most efficient, potentially avoiding almost as many deaths (14,700) while recommending treatment to the fewest number of people (12.9% of people v 17.3% with the Australian and British guidelines). If their "optional" recommendations are included, the US guidelines recommended treating about twice as many people as the New Zealand guidelines (24.5% of the population, an additional 1.4 million people) with almost no increase in the number of deaths avoided. CONCLUSIONS:By focusing recommendations on people with the highest risk of coronary heart disease, the Canadian, US, and European societies guidelines could improve either their effectiveness (in terms of hundreds of avoided deaths) or efficiency (in terms of thousands of fewer people recommended treatment) in the Canadian population.

journal_name

BMJ

authors

Manuel DG,Kwong K,Tanuseputro P,Lim J,Mustard CA,Anderson GM,Ardal S,Alter DA,Laupacis A

doi

10.1136/bmj.38849.487546.DE

subject

Has Abstract

pub_date

2006-06-17 00:00:00

pages

1419

issue

7555

eissn

0959-8138

issn

1756-1833

pii

bmj.38849.487546.DE

journal_volume

332

pub_type

杂志文章,多中心研究
  • Should fertile people have access to in vitro fertilisation?

    abstract::Some existing laws and some proposed legislation regulating the practice of in vitro fertilization (IVF) limit its availability to infertile couples. Dawson and Singer question whether it is reasonable to so restrict access to IVF, and examine some of the medical and social circumstances in which IVF and the related ...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.300.6718.167

    authors: Dawson K,Singer P

    更新日期:1990-01-20 00:00:00

  • Different strategies for screening and prevention of type 2 diabetes in adults: cost effectiveness analysis.

    abstract:OBJECTIVE:To compare four potential screening strategies, and subsequent interventions, for the prevention and treatment of type 2 diabetes: (a) screening for type 2 diabetes to enable early detection and treatment, (b) screening for type 2 diabetes and impaired glucose tolerance, intervening with lifestyle interventio...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.39545.585289.25

    authors: Gillies CL,Lambert PC,Abrams KR,Sutton AJ,Cooper NJ,Hsu RT,Davies MJ,Khunti K

    更新日期:2008-05-24 00:00:00

  • Uptake of systematic reviews and meta-analyses based on individual participant data in clinical practice guidelines: descriptive study.

    abstract:OBJECTIVE:To establish the extent to which systematic reviews and meta-analyses of individual participant data (IPD) are being used to inform the recommendations included in published clinical guidelines. DESIGN:Descriptive study. SETTING:Database maintained by the Cochrane IPD Meta-analysis Methods Group, supplement...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.h1088

    authors: Vale CL,Rydzewska LH,Rovers MM,Emberson JR,Gueyffier F,Stewart LA,Cochrane IPD Meta-analysis Methods Group.

    更新日期:2015-03-06 00:00:00

  • Prevention of suicide: aspirations and evidence.

    abstract::The Health of the Nation white paper set a target for 15% reduction in overall suicide rates by the year 2000. If the targets are to be achieved interventions must be identified which are of proved effectiveness. This paper examines the evidence on the available interventions and points of access to the population at ...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,评审

    doi:10.1136/bmj.308.6938.1227

    authors: Gunnell D,Frankel S

    更新日期:1994-05-07 00:00:00

  • Supplementary feeding with either ready-to-use fortified spread or corn-soy blend in wasted adults starting antiretroviral therapy in Malawi: randomised, investigator blinded, controlled trial.

    abstract:OBJECTIVE:To investigate the effect of two different food supplements on body mass index (BMI) in wasted Malawian adults with HIV who were starting antiretroviral therapy. DESIGN:Randomised, investigator blinded, controlled trial. SETTING:Large, public clinic associated with a referral hospital in Blantyre, Malawi. ...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,随机对照试验

    doi:10.1136/bmj.b1867

    authors: Ndekha MJ,van Oosterhout JJ,Zijlstra EE,Manary M,Saloojee H,Manary MJ

    更新日期:2009-05-22 00:00:00

  • Science, medicine, and the future. Lung cancer.

    abstract::Lung cancer, the most prevalent cancer in the Western world, is mainly caused by smoking. Nevertheless, only 20% of smokers develop lung cancer and while prevention is important, environmental factors are expected to contribute to the predicted rise in the incidence of lung cancer in the next 25 years. Survival of lun...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,评审

    doi:10.1136/bmj.314.7081.652

    authors: Sethi T

    更新日期:1997-03-01 00:00:00

  • Performance of UK National Health Service compared with other high income countries: observational study.

    abstract:OBJECTIVE:To determine how the UK National Health Service (NHS) is performing relative to health systems of other high income countries, given that it is facing sustained financial pressure, increasing levels of demand, and cuts to social care. DESIGN:Observational study using secondary data from key international org...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.l6326

    authors: Papanicolas I,Mossialos E,Gundersen A,Woskie L,Jha AK

    更新日期:2019-11-27 00:00:00

  • Prescription of oxygen concentrators for long term oxygen treatment: reassessment in one district.

    abstract::When oxygen concentrators became available on form FP10 in 1985 the Department of Health and Social Security issued clear guidelines for their prescription for long term treatment. Reassessment of those patients prescribed a concentrator in one district showed that 29 out of 61 patients did not fulfil these criteria. ...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.297.6655.1030

    authors: Walshaw MJ,Lim R,Evans CC,Hind CR

    更新日期:1988-10-22 00:00:00

  • Influence of preceding length of anticoagulant treatment and initial presentation of venous thromboembolism on risk of recurrence after stopping treatment: analysis of individual participants' data from seven trials.

    abstract:OBJECTIVE:To determine how length of anticoagulation and clinical presentation of venous thromboembolism influence the risk of recurrence after anticoagulant treatment is stopped and to identify the shortest length of anticoagulation that reduces the risk of recurrence to its lowest level. DESIGN:Pooled analysis of in...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,meta分析

    doi:10.1136/bmj.d3036

    authors: Boutitie F,Pinede L,Schulman S,Agnelli G,Raskob G,Julian J,Hirsh J,Kearon C

    更新日期:2011-05-24 00:00:00

  • Amblyopia treatment outcomes after screening before or at age 3 years: follow up from randomised trial.

    abstract:OBJECTIVE:To assess the effectiveness of early treatment for amblyopia in children. DESIGN:Follow up of outcomes of treatment for amblyopia in a randomised controlled trial comparing intensive orthoptic screening at 8, 12, 18, 25, 31, and 37 months (intensive group) with orthoptic screening at 37 months only (control ...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1136/bmj.324.7353.1549

    authors: Williams C,Northstone K,Harrad RA,Sparrow JM,Harvey I,ALSPAC Study Team.

    更新日期:2002-06-29 00:00:00

  • The World Health Organisation. WHO in Europe: does it have a role?

    abstract::WHO is under pressure from all sides to justify its existence. Donors want to know what they are getting for their money, and health professionals question the relevance of the organisation's work. The pressure to justify itself is perhaps strongest of all in Europe, where most member countries have fully fledged heal...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.310.6976.389

    authors: Godlee F

    更新日期:1995-02-11 00:00:00

  • Effect of a national primary care pay for performance scheme on emergency hospital admissions for ambulatory care sensitive conditions: controlled longitudinal study.

    abstract:OBJECTIVE:To estimate the impact of a national primary care pay for performance scheme, the Quality and Outcomes Framework in England, on emergency hospital admissions for ambulatory care sensitive conditions (ACSCs). DESIGN:Controlled longitudinal study. SETTING:English National Health Service between 1998/99 and 20...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.g6423

    authors: Harrison MJ,Dusheiko M,Sutton M,Gravelle H,Doran T,Roland M

    更新日期:2014-11-11 00:00:00

  • Risk of breast cancer in relation to the interval since last full term pregnancy.

    abstract:OBJECTIVE:To examine whether the risk of breast cancer is increased by a recent term pregnancy. DESIGN:Population based case-control study. SETTING:Eight areas in the United States. SUBJECTS:Cases were 2279 multiparous women residents of the eight areas aged 25-49 who were diagnosed as having breast cancer during 19...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.308.6945.1672

    authors: Cummings P,Stanford JL,Daling JR,Weiss NS,McKnight B

    更新日期:1994-06-25 00:00:00

  • Cohort study of hepatotoxicity associated with nimesulide and other non-steroidal anti-inflammatory drugs.

    abstract:OBJECTIVE:To estimate the risk of acute hepatotoxicity associated with nimesulide compared with other non-steroidal anti-inflammatory drugs. DESIGN:Retrospective cohort and nested case-control study. SETTING:Umbria region, Italy. PARTICIPANTS:400 000 current, recent, and past users (almost 2 million prescriptions) o...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.327.7405.18

    authors: Traversa G,Bianchi C,Da Cas R,Abraha I,Menniti-Ippolito F,Venegoni M

    更新日期:2003-07-05 00:00:00

  • Change in social status and risk of low birth weight in Denmark: population based cohort study.

    abstract:OBJECTIVE:To estimate the risk of having a low birthweight infant associated with changes in social, environmental, and genetic factors. DESIGN:Population based, historical cohort study using the Danish medical birth registry and Statistic Denmark's fertility database. SUBJECTS:All women who had a low birthweight inf...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.315.7121.1498

    authors: Basso O,Olsen J,Johansen AM,Christensen K

    更新日期:1997-12-06 00:00:00

  • Graduated compression stockings as adjuvant to pharmaco-thromboprophylaxis in elective surgical patients (GAPS study): randomised controlled trial.

    abstract:OBJECTIVES:To investigate whether the use of graduated compression stockings (GCS) offers any adjuvant benefit when pharmaco-thromboprophylaxis is used for venous thromboembolism prophylaxis in patients undergoing elective surgery. DESIGN:Open, multicentre, randomised, controlled, non-inferiority trial. SETTING:Seven...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1136/bmj.m1309

    authors: Shalhoub J,Lawton R,Hudson J,Baker C,Bradbury A,Dhillon K,Everington T,Gohel MS,Hamady Z,Hunt BJ,Stansby G,Warwick D,Norrie J,Davies AH,GAPS trial investigators.

    更新日期:2020-05-13 00:00:00

  • Antibiotic prescribing without documented indication in ambulatory care clinics: national cross sectional study.

    abstract:OBJECTIVES:To identify the frequency with which antibiotics are prescribed in the absence of a documented indication in the ambulatory care setting, to quantify the potential effect on assessments of appropriateness of antibiotics, and to understand patient, provider, and visit level characteristics associated with ant...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,多中心研究

    doi:10.1136/bmj.l6461

    authors: Ray MJ,Tallman GB,Bearden DT,Elman MR,McGregor JC

    更新日期:2019-12-11 00:00:00

  • Incidence of gastric cancer among patients with gastric precancerous lesions: observational cohort study in a low risk Western population.

    abstract:OBJECTIVE:To accurately measure the incidence of gastric cancer among patients with gastric precancerous lesions, and to quantify the excess incidence in comparison with people with normal mucosa on endoscopy and a general population. DESIGN:Population based cohort study. SETTING:Population of Sweden using data from ...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.h3867

    authors: Song H,Ekheden IG,Zheng Z,Ericsson J,Nyrén O,Ye W

    更新日期:2015-07-27 00:00:00

  • Prevalence of asthma in Finnish young men.

    abstract:OBJECTIVE:To determine the prevalence of asthma in cohorts of Finnish young men in the period 1926-89. DESIGN:A retrospective analysis using reports and statistics of Finnish defence forces. SETTING:Call up examinations of candidates for military conscription and examination of conscripts discharged because of poor h...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.301.6746.266

    authors: Haahtela T,Lindholm H,Björkstén F,Koskenvuo K,Laitinen LA

    更新日期:1990-08-04 00:00:00

  • Cost effectiveness of magnetic resonance imaging in the neurosciences.

    abstract:OBJECTIVES:To measure, in a service setting, the effect of magnetic resonance imaging on diagnosis, diagnostic certainty, and patient management in the neurosciences; to measure the cost per patient scanned; to estimate the marginal cost of imaging and compare this with its diagnostic impact; to measure changes in pati...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.303.6815.1435

    authors: Szczepura AK,Fletcher J,Fitz-Patrick JD

    更新日期:1991-12-07 00:00:00

  • Risk factors for development of flucloxacillin associated jaundice.

    abstract:OBJECTIVES:To identify risk factors predisposing to the development of flucloxacillin associated jaundice. DESIGN:Case-control study. Medical records of cases and controls were reviewed and information recorded on standard data collection forms. SETTING:Alfred Hospital recruiting subjects from Melbourne, Sydney, and ...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.306.6872.233

    authors: Fairley CK,McNeil JJ,Desmond P,Smallwood R,Young H,Forbes A,Purcell P,Boyd I

    更新日期:1993-01-23 00:00:00

  • NHSnet in Scottish primary care: lessons for the future.

    abstract:OBJECTIVE:To evaluate the primary care communications initiative, which introduced NHSnet to primary care in Scotland. DESIGN:Semi-structured telephone interviews, postal questionnaire. SETTING:All 15 Scottish health boards, random sample of 1 in 3 of all Scottish general practices. PARTICIPANTS:Information manageme...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.321.7265.878

    authors: Willmot M,Sullivan F

    更新日期:2000-10-07 00:00:00

  • Case-control study of childhood leukaemia and cancer in Scotland: findings for neonatal intramuscular vitamin K.

    abstract:OBJECTIVE:To test the hypothesis of an association between neonatal intramuscular vitamin K and childhood leukaemia and other cancers. DESIGN:Population based case-control study with data abstracted from hospital records. SETTING:Scotland. SUBJECTS:Children aged 0-14 years resident in Scotland from 1991-4 and diagno...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.316.7126.173

    authors: McKinney PA,Juszczak E,Findlay E,Smith K

    更新日期:1998-01-17 00:00:00

  • Lichen planus and liver diseases: a multicentre case-control study. Gruppo Italiano Studi Epidemiologici in Dermatologia (GISED).

    abstract:OBJECTIVE:To assess the association of lichen planus with liver complaints and with known aetiological factors of liver diseases. DESIGN:Multicentre case-control study. Interviews were conducted by trained medical investigators on the basis of a structured questionnaire. At the interview patients and controls were ask...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 临床试验,杂志文章,多中心研究

    doi:10.1136/bmj.300.6719.227

    authors:

    更新日期:1990-01-27 00:00:00

  • Diurnal variation in incidence of stroke: Oxfordshire community stroke project.

    abstract:OBJECTIVE:To determine whether diurnal variation occurs in the onset of stroke. DESIGN:Community based study over four years. SETTING:Oxfordshire, United Kingdom. SUBJECTS:105,000 people, of whom 675 had a first ever stroke. 545 had a cerebral infarction, 66 had primary intracerebral haemorrhage, 33 had subarachnoid...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.304.6820.155

    authors: Wroe SJ,Sandercock P,Bamford J,Dennis M,Slattery J,Warlow C

    更新日期:1992-01-18 00:00:00

  • Salmeterol in nocturnal asthma: a double blind, placebo controlled trial of a long acting inhaled beta 2 agonist.

    abstract:OBJECTIVE:To determine whether inhaled salmeterol, a new long acting inhaled beta adrenergic agonist, reduces nocturnal bronchoconstriction and improves sleep quality in patients with nocturnal asthma. DESIGN:Randomised, double blind, placebo controlled crossover study. SETTING:Hospital outpatient clinics in Edinburg...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1136/bmj.301.6765.1365

    authors: Fitzpatrick MF,Mackay T,Driver H,Douglas NJ

    更新日期:1990-12-15 00:00:00

  • Dental disease and risk of coronary heart disease and mortality.

    abstract:OBJECTIVE:To investigate a reported association between dental disease and risk of coronary heart disease. SETTING:National sample of American adults who participated in a health examination survey in the early 1970s. DESIGN:Prospective cohort study in which participants underwent a standard dental examination at bas...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.306.6879.688

    authors: DeStefano F,Anda RF,Kahn HS,Williamson DF,Russell CM

    更新日期:1993-03-13 00:00:00

  • Process and impact of mergers of NHS trusts: multicentre case study and management cost analysis.

    abstract:OBJECTIVE:To study the processes involved in and impact of mergers between NHS trusts, including the effect on management costs. DESIGN:Cross sectional study involving in depth interviews and documentary analysis; case study to compare savings in management costs between case trusts and control trusts. SETTING:Nine t...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,多中心研究

    doi:10.1136/bmj.325.7358.246

    authors: Fulop N,Protopsaltis G,Hutchings A,King A,Allen P,Normand C,Walters R

    更新日期:2002-08-03 00:00:00

  • Fibrinogen and lipid concentrations as risk factors for transient ischaemic attacks and minor ischaemic strokes.

    abstract:OBJECTIVES:To determine whether fibrinogen and lipid concentrations are risk factors for ischaemic stroke. DESIGN:Case-control study with a population based comparison within the overall study. SETTING:Oxfordshire community stroke project and a neurology clinic. SUBJECTS:105 patients who had a transient ischaemic at...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.303.6803.605

    authors: Qizilbash N,Jones L,Warlow C,Mann J

    更新日期:1991-09-14 00:00:00

  • Preregistration house officers in the four Thames regions: I. Survey of education and workload.

    abstract:OBJECTIVE:To assess the education and workload of preregistration house officers in the four Thames regions. DESIGN:Postal questionnaire. SETTING:Teaching and non-teaching hospitals in the four Thames regions. PARTICIPANTS:1064 Preregistration house officers. RESULTS:Response rate was 70% (740 replies). Nine per ce...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.300.6726.713

    authors: Dent TH,Gillard JH,Aarons EJ,Crimlisk HL,Smyth-Pigott PJ

    更新日期:1990-03-17 00:00:00