scholarly journals Evaluating the number of unvaccinated people needed to exclude to prevent SARS-CoV-2 transmissions

2021 ◽  
Author(s):  
Aaron Prosser ◽  
Bartosz Helfer ◽  
David L. Streiner
Keyword(s):  
Decision Support ◽  
Primary Prevention ◽  
Significant Risk ◽  
Infection Risk ◽  
Transmission Risk ◽  
Severe Illness ◽  
Number Needed To Treat ◽  
Transmission Event ◽  
Competing Interests ◽  
Link Type

AbstractBackgroundVaccine mandates and vaccine passports (VMVP) for SARS-CoV-2 are thought to be a path out of the pandemic by increasing vaccination through coercion and excluding unvaccinated people from different settings because they are viewed as being at significant risk of transmitting SARS-CoV-2. While variants and waning efficacy are relevant, SARS-CoV-2 vaccines reduce the risk of infection, transmission, and severe illness/hospitalization in adults. Thus, higher vaccination levels are beneficial by reducing healthcare system pressures and societal fear. However, the benefits of excluding unvaccinated people are unknown.MethodsA method to evaluate the benefits of excluding unvaccinated people to reduce transmissions is described, called the number needed to exclude (NNE). The NNE is analogous to the number needed to treat (NNT=1/ARR), except the absolute risk reduction (ARR) is the baseline transmission risk in the population for a setting (e.g., healthcare). The rationale for the NNE is that exclusion removes all unvaccinated people from a setting, such that the ARR is the baseline transmission risk for that type of setting, which depends on the secondary attack rate (SAR) typically observed in that type of setting and the baseline infection risk in the population. The NNE is the number of unvaccinated people who need to be excluded from a setting to prevent one transmission event from unvaccinated people in that type of setting. The NNE accounts for the transmissibility of the currently dominant Delta (B.1.617.2) variant to estimate the minimum NNE in six types of settings: households, social gatherings, casual close contacts, work/study places, healthcare, and travel/transportation. The NNE can account for future potentially dominant variants (e.g., Omicron, B.1.1.529). To assist societies and policymakers in their decision-making about VMVP, the NNEs were calculated using the current (mid-to-end November 2021) baseline infection risk in many countries.FindingsThe NNEs suggest that at least 1,000 unvaccinated people likely need to be excluded to prevent one SARS-CoV-2 transmission event in most types of settings for many jurisdictions, notably Australia, California, Canada, China, France, Israel, and others. The NNEs of almost every jurisdiction examined are well within the range of the NNTs of acetylsalicylic acid (ASA) in primary prevention of cardiovascular disease (CVD) (≥ 250 to 333). This is important since ASA is not recommended for primary prevention of CVD because the harms outweigh the benefits. Similarly, the harms of exclusion may outweigh the benefits. These findings depend on the accuracy of the model assumptions and the baseline infection risk estimates.ConclusionsVaccines are beneficial, but the high NNEs suggest that excluding unvaccinated people has negligible benefits for reducing transmissions in many jurisdictions across the globe. This is because unvaccinated people are likely not at significant risk – in absolute terms – of transmitting SARS-CoV-2 to others in most types of settings since current baseline transmission risks are negligible. Consideration of the harms of exclusion is urgently needed, including staffing shortages from losing unvaccinated healthcare workers, unemployment/unemployability, financial hardship for unvaccinated people, and the creation of a class of citizens who are not allowed to fully participate in many areas of society.RegistrationCRD42021292263FundingThis study received no grant from any funding agency, commercial, or not-for-profit sectors. It has also received no support of any kind from any individual or organization. BH is supported by a personal research grant from the University of Wroclaw within the “Excellence Initiative – Research University” framework and by a scholarship from the Polish Ministry of Education and Science. None of these institutions were involved in this research and did not fund it directly.Competing interestsThe authors have no competing interests to declare.Ethical approvalNot applicable. All the work herein was performed using publicly available data.Data reportingThe data used in this work are available at https://tinyurl.com/4m8mm4jh and https://decision-support-tools.com/.

scholarly journals A study of the benefits of vaccine mandates and vaccine passports for SARS-CoV-2

2021 ◽  
Author(s):  
Aaron Prosser ◽  
David L. Streiner
Keyword(s):  
General Population ◽  
Cohort Studies ◽  
Risk Reduction ◽  
Infection Risk ◽  
Transmission Risk ◽  
Baseline Risk ◽  
Severe Illness ◽  
Vaccine Mandates ◽  
Transmission Studies ◽  
Index Cases

Objective: To evaluate the benefits of vaccine mandates and vaccine passports (VMVP) for SARS-CoV-2 by estimating the benefits of vaccination and exclusion of unvaccinated people from different settings. Methods: Quantified the benefits of vaccination using meta-analyses of randomized controlled trials (RCTs), cohort studies, and transmission studies to estimate the relative risk reduction (RRR), absolute risk reduction (ARR), and number needed to vaccinate (NNV) for transmission, infection, and severe illness/hospitalization. Estimated the baseline infection risk and the baseline transmission risks for different settings. Quantified the benefits of exclusion using these data to estimate the number of unvaccinated people needed to exclude (NNE) to prevent one transmission in different settings. Modelled how the benefits of vaccination and exclusion change as a function of baseline infection risk. Studies were identified from recent systematic reviews and a search of MEDLINE, MEDLINE In-Process, Embase, Global Health, and Google Scholar. Results: Data on infection and severe illness/hospitalization were obtained from 10 RCTs and 19 cohort studies of SARS-CoV-2 vaccines, totalling 5,575,049 vaccinated and 4,341,745 unvaccinated participants. Data from 7 transmission studies were obtained, totalling 557,020 index cases, 49,328 contacts of vaccinated index cases, and 1,294,372 contacts of unvaccinated index cases. The estimated baseline infection risk in the general population is 3.04%. The estimated breakthrough infection risk in the vaccinated population is 0.57%. Vaccines are very effective at reducing the risk of infection (RRR=88%, ARR=2.59%, NNV=39) and severe illness/hospitalization (RRR=89%, ARR=0.15%, NNV=676) in the general population. While the latter effect is small, vaccines nearly eliminate the baseline risk of severe illness/hospitalization (0.16%). Among an infected persons closest contacts (primarily household members), vaccines reduce transmission risk (RRR=41%, ARR=11.04%, NNV=9). In the general population, the effect of vaccines on transmission risk is likely very small for most settings and baseline infection risks (NNVs ≥ 1,000). Infected vaccinated people have a nontrivial transmission risk for their closest contacts (14.35%), but it is less than unvaccinated people (23.91%). The transmission risk reduction gained by excluding unvaccinated people is very small for most settings: healthcare (NNE=4,699), work/study places (NNE=2,193), meals/gatherings (NNE=531), public places (NNE=1,731), daily conversation (NNE=587), and transportation (NNE=4,699). Exclusion starts showing benefits on transmission risk for some settings when the baseline infection risk is between 10% to 20%. Conclusions: The benefits of VMVP are clear: the coercive element to these policies will likely lead to increased vaccination levels. Our study shows that higher vaccination levels will drive infections lower and almost eliminate severe illness/hospitalization from the general population. This will substantially lower the burden on healthcare systems. The benefits of exclusion are less clear. The NNEs suggest that hundreds, and even thousands, of unvaccinated people may need to be excluded from various settings to prevent one SARS-CoV-2 transmission from unvaccinated people. Therefore, consideration of the costs of exclusion is warranted, including staffing shortages from losing unvaccinated healthcare workers, unemployment/unemployability, financial hardship for unvaccinated people, and the creation of a class of citizens who are not allowed to fully participate in many areas of society. Registration: This study is not registered. Funding: This study received no grant from any funding agency, commercial, or not-for-profit sectors. It has also received no support of any kind from any individual or organization.

scholarly journals Radial versus femoral access for coronary angiography and interventions: a systematic review and meta-analysis of randomized trials

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Chiarito ◽  
D Cao ◽  
J Nicolas ◽  
A Roumeliotis ◽  
D Power ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Angiography ◽  
Major Bleeding ◽  
Randomized Trials ◽  
Significant Risk ◽  
Number Needed To Treat ◽  
Femoral Access ◽  
Coronary Syndrome ◽  
Radial Access ◽  
All Cause Mortality

Abstract Background The presence of any benefits associated with radial or femoral access among patients undergoing coronary angiography and percutaneous coronary interventions (PCI) is still debated. Purpose Our aim is to provide a comprehensive quantitative appraisal of the effects of access site on the risks of stroke, myocardial infarction, and major bleeding in patients undergoing coronary angiography with or without PCI. Methods In January 2020, we searched PubMed, Embase, and meeting abstracts for randomized trials comparing radial versus femoral access for coronary angiography with or without subsequent PCI. Odds ratios (OR) were used as metric of choice for treatment effects with random-effects models. Co-primary efficacy endpoints were stroke and myocardial infarction. Primary safety endpoint was major bleeding. Secondary endpoints were all cause mortality and vascular complications. Heterogeneity was assessed with the I-squared index. This study is registered with PROSPERO. Results We identified 31 trials, including 30,414 patients. Risks of stroke (OR 1.11, 95% CI 0.76–1.64, I2=0%) and myocardial infarction (OR 0.90, 95% CI 0.79–1.03, I2=0%) were comparable between radial and femoral access. Radial access was associated with a reduction for the risk of major bleeding as compared to femoral access (OR 0.53, 95% CI 0.42–0.67, I2=3.3%) with a number needed to treat of 92. Findings were consistent regardless clinical features and procedure performed, with the only exception of an increased benefit of the radial access in patients with chronic coronary syndrome (p forinteraction=0.005). The risk for all-cause mortality (OR 0.73, 95% CI 0.61–0.89, I2=0%) and vascular complication (OR 0.32, 95% CI 0.23–0.44, I2=16.7%) was significantly lower in the radial compared to femoral access group. Conclusions In patients undergoing coronary angiography with or without PCI, radial compared to femoral access did not reduce the risk of stroke and myocardial infarction, with no impact on the effect estimates of clinical presentation, age, gender, or subsequent PCI. Whereas, radial access is associated with a significant risk reduction of major bleeding as compared to femoral access. The benefit favoring radial access is of important clinical relevance in view of the relatively low number needed to treat to prevent a major bleeding and the significant impact on mortality. Funding Acknowledgement Type of funding source: None

scholarly journals Coxiella burnetii seroprevalence and risk factors in sheep farmers and farm residents in The Netherlands

2013 ◽  
Vol 142 (6) ◽  
pp. 1231-1244 ◽  
Author(s):  
M. M. A. De LANGE ◽  
B. SCHIMMER ◽  
P. VELLEMA ◽  
J. L. A. HAUTVAST ◽  
P. M. SCHNEEBERGER ◽  
...  
Keyword(s):  
Risk Factors ◽  
The Netherlands ◽  
Coxiella Burnetii ◽  
High Frequency ◽  
Significant Risk ◽  
Infection Risk ◽  
Multivariate Logistic Regression ◽  
Dairy Sheep ◽  
Sheep Farm ◽  
Farm Residents

SUMMARYIn this study, Coxiella burnetii seroprevalence was assessed for dairy and non-dairy sheep farm residents in The Netherlands for 2009–2010. Risk factors for seropositivity were identified for non-dairy sheep farm residents. Participants completed farm-based and individual questionnaires. In addition, participants were tested for IgG and IgM C. burnetii antibodies using immunofluorescent assay. Risk factors were identified by univariate, multivariate logistic regression, and multivariate multilevel analyses. In dairy and non-dairy sheep farm residents, seroprevalence was 66·7% and 51·3%, respectively. Significant risk factors were cattle contact, high goat density near the farm, sheep supplied from two provinces, high frequency of refreshing stable bedding, farm started before 1990 and presence of the Blessumer breed. Most risk factors indicate current or past goat and cattle exposure, with limited factors involving sheep. Subtyping human, cattle, goat, and sheep C. burnetii strains might elucidate their role in the infection risk of sheep farm residents.

scholarly journals Primary prevention lessons learned from those with HIV in Chennai, India

Sexual Health ◽  
2011 ◽  
Vol 8 (2) ◽  
pp. 199 ◽  
Author(s):  
Ellen Setsuko Hendriksen ◽  
A. K. Sri Krishnan ◽  
Snigda Vallabhaneni ◽  
Sethu Johnson ◽  
Sudha Raminani ◽  
...  
Keyword(s):  
Primary Prevention ◽  
High Risk ◽  
Risk Group ◽  
Infected Individual ◽  
High Risk Group ◽  
Lessons Learned ◽  
Transmission Risk ◽  
Hiv Education ◽  
Sexual Roles ◽  
Male Clients

Background As each HIV-infected individual represents a breakdown of HIV primary prevention measures, formative data from representative individuals living with HIV can help shape future primary prevention interventions. Little is known about sexual behaviours and other transmission risk factors of high-risk group members who are already HIV-infected in Chennai, India. Methods: Semi-structured qualitative interviews were conducted with 27 HIV-infected individuals representing each high-risk group in Chennai (five men who have sex with men (MSM), five female commercial sex workers (CSW), four truckers and other men who travel for business, four injecting drug users (IDU), five married male clients of CSW, and four wives of CSW clients, MSM, truckers, and IDU). Results: Themes relevant to HIV primary prevention included: (1) HIV diagnosis as the entry into HIV education and risk reduction, (2) reluctance to undergo voluntary counselling and testing, (3) gender and sexual roles as determinants of condom use, (4) misconceptions about HIV transmission, and (5) framing and accessibility of HIV education messages. Conclusions: These qualitative data can be used to develop hypotheses about sexual risk taking in HIV-infected individuals in South India, inform primary prevention intervention programs, and improve primary prevention efforts overall.

scholarly journals Vaping and subsequent comorbidities potentially associated with increased mortality and more severe illness in COVID-19: a narrative review

2021 ◽  
Keyword(s):  
Risk Factors ◽  
Cigarette Smoking ◽  
Health Risks ◽  
Older Patients ◽  
Significant Risk ◽  
Self Report ◽  
Severe Illness ◽  
Protective Effects ◽  
Cigarette Use

Introduction: COVID-19 (or COVID) is a highly virulent viral disease which more frequently presents severe infection in specific populations, such as the elderly, patients with hypertension, patients with respiratory disease, and patients who smoke. The effects vaping (i.e., an electronic cigarette or JUUL device) has on COVID progression remains unclear, because there is an information paucity correlating e-cigarette use and COVID. This review sought to identify links between vape use and COVID severity via literature review. Additionally, because there is more widespread information about cigarette smoking than about vaping, this review sought to illustrate commonalities between smoking and vaping. If smoking and vaping are deemed near-identical practices, then it is possible the effects of smoking on human health and on COVID disease could be comparable in vaping. Methods: Several searches were performed on PubMed with MeSH headings and JSTOR between 17 December 2020 and 22 December 2020. Search results were excluded if they were not trials or controlled clinical trials, if the articles were not about COVID, if the articles were about smoking behaviors or habits, or if the articles were not related to vaping or smoking. Key findings were summarized and tabled based on relevance, substantiability, and applicability to COVID. Results: Multiple sources viewed smoking and vaping as equal risk factors for COVID disease, whereas other sources viewed the two as unique risk factors. Because of this controversy, it is challenging to view the two practices as similar enough to pose equivalent risks for COVID. Both practices pose significant health risks to its users, but these health risks are unique to each practice. Discussion: There are several limitations which exacerbate ambiguity—(1) it is unclear how harmful smoking is for COVID patients, because several publications found smoking may have protective effects; (2) few older patients vape, but yet most severe COVID cases occur in older populations; (3) older patients and impoverished patients show a statistically significant risk for severe COVID disease independent of other factors; (4) vaping is a relatively new practice, and there are few patients who self-report long-term e-cigarette use or long-term adverse effects as a result thereof. Conclusion: Although vaping may present serious health risks, clinically, it is uncertain how significantly vaping affects COVID disease, especially when compared against cigarette smoking. More research is needed on both the effects of vaping on COVID and the likeness of vaping versus smoking.

scholarly journals HEPATITIS B AND C: FREQUENCY, MODES OF TRANSMISSION AND RISK FACTORS ALONG WITH SOME UNORTHODOX ROUTES OF SPREAD

2020 ◽  
Vol 9 (3) ◽  
pp. 161-165
Author(s):  
Iftikhar Haider Naqvi ◽  
Abu Talib ◽  
Gohar Baloch ◽  
Khalid Mahmood ◽  
Zahid Qadari
Keyword(s):  
Risk Factors ◽  
Chronic Hepatitis ◽  
Hepatitis B ◽  
Chronic Hepatitis B ◽  
Dental Treatment ◽  
Significant Risk ◽  
Transmission Risk ◽  
Retrospective Case ◽  
Leech Therapy ◽  
Ear Piercing

Background: Pakistan's being a country placed in intermediate endemicity zone of HBV and HCV, with rising population, there is lack scarcity of knowledge about transmission of risk factors specially unorthodox and frequency of this health challenge. Methods: A retrospective case control study where case records of all patients aged from 18 - 70 years from 2012 to 2017 with either gender diagnosed as chronic hepatitis B and C were included. Information about shave from barber-shop, sharing of toothbrush at home, tattooing, cautery, and ear piercing were collected. Information about unorthodox risks for transmission of HBV and HCV, like skin branding, cupping of blood, circumcision by the barber, sharing of tooth brushes and leech therapy was collected. Results: Among 1134 patients of chronic hepatitis B (HBV) and chronic hepatitis C (HCV), Age > 35 years, shave from barber and dental treatment were found to be risk factor for both HCV and HBV transmission. Amongst unorthodox risk factors like skin branding, cupping of blood, circumcision by the barber, sharing of tooth brushes and leech therapy, only cupping of blood (Hijama) was a significant risk for transmission of both HBV and HCV. Conclusion: Viral related chronic hepatitis is frequently reported problem in this part of the world where HCV supersedes HBV. Socieodemographic factor like age > 35 year, shave from barbers and dental treatment were risk factors for transmission of both HCV and HBV. Among orthodox routes of transmission blood cupping (hijama) has shown as a significant transmission risk for both HCV and HBV.

scholarly journals Comparison of COVID-19 outcomes in organ transplant recipients (OTr) and non-transplant patients: a study protocol for rapid review

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Alexis H. Lerner ◽  
Elizabeth J. Klein ◽  
Anna Hardesty ◽  
Orestis A. Panagiotou ◽  
Chelsea Misquith ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Organ Transplant ◽  
Open Science ◽  
Rapid Review ◽  
Secondary Outcome ◽  
Severe Illness ◽  
Link Type ◽  
Increased Risk ◽  
Potential Sources ◽  
Measure Of Association

Abstract Background The COVID-19 pandemic has devastated the global community with nearly 4.9 million deaths as of October 2021. While organ transplant (OT) recipients (OTr) may be at increased risk for severe COVID-19 due to their chronic immunocompromised state, outcomes for OTr with COVID-19 remain disputed in the literature. This review will examine whether OTr with COVID-19 are at higher risk for severe illness and death than non-immunocompromised individuals. Methods MEDLINE (via Ovid and PubMed) and EMBASE (via Embase.com) will be searched from December 2019 to October 2021 for observational studies (including cohort and case-control) that compare COVID-19 clinical outcomes in OTr to those in individuals without history of OT. The primary outcome of interest will be mortality as defined in each study, with possible further analyses of in-hospital mortality, 28 or 30-day mortality, and all-cause mortality versus mortality attributable to COVID-19. The secondary outcome of interest will be the severity of COVID-19 disease, most frequently defined as requiring intensive care unit admission or mechanical ventilation. Two reviewers will independently screen all abstracts and full-text articles. Potential conflicts will be resolved by a third reviewer and potentially discussion among all investigators. Methodological quality will be appraised using the Newcastle-Ottawa Scale. If data permit, we will perform random-effects meta-analysis with the Sidik-Jonkman estimator and the Hartung-Knapp adjustment for confidence intervals to estimate a summary measure of association between histories of transplant with each outcome. Potential sources of heterogeneity will be explored using meta-regression. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., subgroup analysis) considering least minimal adjustment for confounders. Discussion This rapid review will assess the available evidence on whether OTr diagnosed with COVID-19 are at higher risk for severe illness and death compared to non-immunocompromised individuals. Such knowledge is clinically relevant and may impact risk stratification, allocation of organs and healthcare resources, and organ transplantation protocols during this, and future, pandemics. Systematic review registration Open Science Framework (OSF) registration DOI: 10.17605/osf.io/4n9d7.

scholarly journals Role of Aspirin for primary prevention of cardiovascular and all-cause mortality events in diabetes: An updated meta-analysis of randomized controlled trials.

2021 ◽  
Author(s):  
Hua Ma ◽  
QIng Gu ◽  
Huining Niu ◽  
Xiaohua Li ◽  
Rong Wang
Keyword(s):  
Cardiovascular Disease ◽  
Primary Prevention ◽  
Meta Analysis ◽  
Significant Risk ◽  
Diabetic Patients ◽  
Primary Endpoints ◽  
All Cause Mortality ◽  
Patients With Diabetes ◽  
Rule Out

Background: The use of Aspirin in the primary prevention of cardiovascular disease (CVD) is still a topic of debate, especially in patients with diabetes. The present meta-analysis aims to rule out the efficacy of Aspirin in patients with diabetes and to compare the effectiveness of Aspirin with a placebo (or no treatment) for the primary prevention of CVD and all-cause mortality events in people with diabetes. Materials and Methods: An extensive and systematic search was conducted in Medline (via PubMed), Cinahl (via Ebsco), Scopus, and Web of Sciences from 1988 to December 2020. A detailed literature search was conducted using Aspirin, cardiovascular disease (CVD), diabetes, and efficacy to identify trials of patients with diabetes who received Aspirin for primary prevention of CVD. Demographic details with the primary outcome of events and bleeding outcomes were analyzed. The risk of bias (RoB) in included studies was evaluated using the QUADAS-2 tool. Results: A total of 5 studies out of 13 were included with 23,570 diabetic patients; 11,738 allocated to Aspirin and 11,832 allocated to the placebo group. In patients with diabetes, there was no difference between Aspirin and placebo with respect to the risk of all-cause death with a confidence interval (CI) varying 0.63 to 1.17. In addition, there were no differences in the bleeding outcomes with an odds ratio of 1.4411 (CI 0.47 to 4.34). Conclusion: Aspirin has no significant risk on primary endpoints of cardiovascular events and the bleeding outcomes in diabetic patients compared to placebo. More research on the use of Aspirin alone or in combination with other antiplatelet drugs is required in patients with diabetes to supplement currently available research.

Absence of Association Between Abatacept Exposure and Initial Infection in Patients With Juvenile Idiopathic Arthritis

2021 ◽  
pp. jrheum.200154
Author(s):  
Nicolino Ruperto ◽  
Hermine I. Brunner ◽  
Nikolay Tzaribachev ◽  
Gabriel Vega-Cornejo ◽  
Ingrid Louw ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Pediatric Patients ◽  
Opportunistic Infections ◽  
Infection Risk ◽  
Rank Tests ◽  
Link Type ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Exposure Levels ◽  
The Relationship

Objective To assess the relationship between infection risk and abatacept exposure levels in patients with polyarticular-course juvenile idiopathic arthritis (pJIA) following treatment with subcutaneous and intravenous abatacept. Methods Data from two published studies (NCT01844518, NCT00095173) of abatacept treatment in pediatric patients were analyzed. One study treated patients aged 2–17 years with subcutaneous abatacept and the other treated patients aged 6–17 years with intravenous abatacept. Association between serum abatacept exposure measures and infection was evaluated using Kaplan–Meier plots of probability of first infection versus time on treatment by abatacept exposure quartiles and log-rank tests. Number of infections by abatacept exposure quartiles was investigated. Results Overall, 343 patients were included in this analysis: 219 patients received subcutaneous abatacept and 124 patients received intravenous abatacept. Overall, 237/343 (69.1%) patients had ≥1 infection over 24 months. No significant difference in time to first infection across four quartiles of abatacept exposure levels was observed in the pooled (p = 0.4458), subcutaneous (2–5 years p = 0.9305; 6–17 years p = 0.4787), or intravenous (p = 0.4999) analyses. Concomitant use of methotrexate and glucocorticoids (at baseline and throughout) with abatacept did not increase infection risk across the abatacept exposure quartiles. There was no evidence of association between number of infections and abatacept exposure quartiles. No opportunistic infections related to abatacept were reported. Conclusion In patients aged 2–17 years with pJIA, no evidence of association between higher levels of exposure to intravenous or subcutaneous abatacept and incidence of infection was observed.

Abstract 05: Assessing Population Impact of Statin Treatment for Primary Prevention of Atherosclerotic Cardiovascular Diseases in US

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Quanhe Yang ◽  
Yuna Zhong ◽  
Catheen Gillespie ◽  
Robert Merritt ◽  
Barbara Bowman ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Adverse Effects ◽  
Randomized Clinical Trials ◽  
Statin Treatment ◽  
Population Based ◽  
Number Needed To Treat ◽  
Atherosclerotic Cardiovascular Disease ◽  
Population Impact ◽  
New Guidelines ◽  
Statin Use

Introduction: American College of Cardiology/American Heart Association (ACC/AHA) new cholesterol treatment guidelines recommend consideration of statin treatment for a larger proportion of population for the primary prevention of atherosclerotic cardiovascular disease (ASCVD). It is important to assess the population impact of statin treatment under these new guidelines. Hypothesis: We assessed the hypothesis that increased statin use for the primary prevention of ASCVD might be accompanied by adverse effects among population. Methods: We used 2010 US Census, Multiple Cause Mortality, Third National Health and Nutrition Examination Survey Linked Mortality File (NHANES III 1988-2006, n=7095) and NHANES 2005-2010 (n=3178) participants 40-75 years of age to estimate prevalence of statin use, annual ASCVD deaths prevented and excess adverse effects by age, sex, and race/ethnicity if everyone followed updated guidelines. Results: Among 33.0 million adults aged 40-75 years meeting new guidelines for primary prevention of ASCVD (12.4 million with diabetes and 20.6 without diabetes but with a predicted 10-year ASCVD risk ≥7.5% and 70 ≤ low-density lipoprotein (LDL) ≤189 mg/dL), 26.9% (8.8 million) were on statins, indicating an additional 24.2 million potentially eligible for statin treatment (7.7 million with diabetes and 16.5 million without). Among the 7.7 million with diabetes, assuming 100% statin use, expected annual ASCVD deaths prevented were 2,514 (95% CI 592-4,142) and number-needed-to-treat (NNT) was 3,063 (1,860-13,017). The additional cases of myopathy based on estimates from randomized clinical trials (RCT) was 482 (0-2239) and number-needed-to-harm (NNH) was 15,992 (3,440-∞), and was 11,801 (9,251-14,916) and NNH 653 (516-833) based on estimates from population-based studies. Among 16.5 million without diabetes, ASCVD deaths prevented were 5,425 (1,276-8,935) with NNT 3,039 (1,845-12,914). The additional diabetes cases were 16,406 (4,922-26,250) with NNH 1,005 (628-3,349). Additional cases of myopathy was 1,030 (0-4,791) with NNH 15,996 3,441-∞) based on RCT estimates, and 24,302 (19,363-30,292) with NNH 678 (544-851) for population-based studies. ASCVD deaths prevented increased with age and >70% of ASCVD deaths prevented would occur among adults aged ≥60 years. Conclusions: Under ACC/AHA new guidelines for primary prevention of ASCVD by statin, assuming all those eligible took a statin, up to 12.6% of annual ASCVD deaths could be prevented, but could be accompanied by additional cases of diabetes and myopathy.

Sign in / Sign up

Export Citation Format

Share Document