{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,3,19]],"date-time":"2024-03-19T18:38:09Z","timestamp":1710873489734},"reference-count":48,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2015,11,11]],"date-time":"2015-11-11T00:00:00Z","timestamp":1447200000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"DOD","award":["W81 XWH 09-2-0175"],"award-info":[{"award-number":["W81 XWH 09-2-0175"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2017,4]]},"abstract":"Abstract<\/jats:title>Rationale, aims and objectives<\/jats:title>The A<\/jats:styled-content>merican C<\/jats:styled-content>ollege of C<\/jats:styled-content>ardiology and A<\/jats:styled-content>merican H<\/jats:styled-content>eart A<\/jats:styled-content>ssociation (ACC<\/jats:styled-content>\/AHA<\/jats:styled-content>) statin guidelines recommend that people with risk of cardio\u2010vascular disease (CVD<\/jats:styled-content>) \u22657.5% over 10 years should be treated with statins. This recommendation ignores individual patient CVD<\/jats:styled-content> risks and preferences. We compared the ACC<\/jats:styled-content>\/AHA<\/jats:styled-content> guidelines to the following management strategies a) individualized statins treatment based on F<\/jats:styled-content>ramingham R<\/jats:styled-content>isk S<\/jats:styled-content>core (FRS<\/jats:styled-content>), b) treat none, c) treat all.<\/jats:p><\/jats:sec>Methods<\/jats:title>We employed regret\u2010based decision curve analysis to evaluate the optimal treatment strategy. We used data on 5013 participants from the second generation of the Framingham Heart Study. We assessed regret of each treatment strategy [treat according to FRS<\/jats:styled-content> vs. treat none vs. treat all] as a function of emotionally felt loss of treatment benefits and incurred treatment harms. We calculated the difference between regret associated with one strategy compared with the other and expressed it as N<\/jats:styled-content>et E<\/jats:styled-content>xpected R<\/jats:styled-content>egret D<\/jats:styled-content>ifference (NERD<\/jats:styled-content>). Two strategies are identical if NERD<\/jats:styled-content>\u2009=\u20090.<\/jats:p><\/jats:sec>Results<\/jats:title>Treatment according to ACC<\/jats:styled-content>\/AHA<\/jats:styled-content> guidelines represents the optimal strategy only if the patient values avoiding heart disease 12 times more than harms related to statins. For values of benefit\/harms (B<\/jats:styled-content>\/H<\/jats:styled-content>) <12, treatment according to FRS<\/jats:styled-content> represents the optimal strategy. For B<\/jats:styled-content>\/H<\/jats:styled-content> <3, \u2018treat none\u2019 represents equally acceptable strategy. Adopting a threshold of 10% recommended by other professional organizations would decrease over\u2010treatment by more than 60% without significantly affecting under\u2010treatment.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>Under most realistic scenarios, individualizing statins treatment, or not recommending statins at all, represents the optimal strategy for primary prevention of heart disease.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jep.12473","type":"journal-article","created":{"date-parts":[[2015,11,11]],"date-time":"2015-11-11T09:52:58Z","timestamp":1447235578000},"page":"241-250","source":"Crossref","is-referenced-by-count":6,"title":["Determining optimal threshold for statins prescribing: individualization of statins treatment for primary prevention of cardiovascular disease"],"prefix":"10.1111","volume":"23","author":[{"given":"Benjamin","family":"Djulbegovic","sequence":"first","affiliation":[{"name":"USF Health Program for Comparative Effectiveness Research Division for Evidence\u2010Based Medicine Department of Internal Medicine University of South Florida Tampa FL USA"},{"name":"Departments of Hematology and Health Outcome Behavior H. Lee Moffitt Cancer Center and Research Institute Tampa FL USA"},{"name":"Tampa General Hospital Tampa FL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Athanasios","family":"Tsalatsanis","sequence":"additional","affiliation":[{"name":"USF Health Program for Comparative Effectiveness Research Division for Evidence\u2010Based Medicine Department of Internal Medicine University of South Florida Tampa FL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iztok","family":"Hozo","sequence":"additional","affiliation":[{"name":"Department of Mathematics Indiana University Gary IN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,11,11]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"Centers for Disease Control and Prevention. \u201cLeading Causes of Death\u201d. Available at:http:\/\/www.cdc.gov\/nchs\/fastats\/leading\u2010causes\u2010of\u2010death.htm(last accessed 15 October 2015)."},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60367-5"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD009217.pub2"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.11.002"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacl.2014.07.007"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.216"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-154-9-201105030-00008"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.699579"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.1335"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.2307\/1884852"},{"key":"e_1_2_6_12_1","volume-title":"Philosophical Essays Concerning Human Understanding","author":"Hume D.","year":"1748"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9780511618031"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/eci.12421"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6947-10-51"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198005153022003"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197507312930505"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0040026"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.seminhematol.2008.04.006"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1207\/s15327663jcp1701_3"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X08315249"},{"key":"e_1_2_6_22_1","first-page":"323","article-title":"Clarification and corrections of acceptable regret model","volume":"29","author":"Hozo I.","year":"2009","journal-title":"Medical Decision Making"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.650"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6947-11-77"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/eci.12421"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X06295361"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6947-8-53"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X06295361"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1315665"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.284657"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-158-7-201304020-00004"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-159-1-201307020-00022"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.110"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1209500"},{"key":"e_1_2_6_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.27321"},{"key":"e_1_2_6_36_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000000310"},{"key":"e_1_2_6_37_1","doi-asserted-by":"publisher","DOI":"10.1207\/s15327663jcp1701_3"},{"key":"e_1_2_6_38_1","volume-title":"Rationality and the Reflective Mind","author":"Stanovich K. E.","year":"2011"},{"key":"e_1_2_6_39_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6947-14-47"},{"key":"e_1_2_6_40_1","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X04263163"},{"key":"e_1_2_6_41_1","unstructured":"Tsalatsanis A. Hozo I.&Djulbegovic B.(2014)Empirical evaluation of regret and acceptable regret model. 36th Annual Meeting of Society of Medical Decision Making Miami October 19\u201322."},{"key":"e_1_2_6_42_1","doi-asserted-by":"publisher","DOI":"10.1348\/014466607X258704"},{"key":"e_1_2_6_43_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0134038"},{"key":"e_1_2_6_44_1","doi-asserted-by":"publisher","DOI":"10.1257\/000282803322655392"},{"key":"e_1_2_6_45_1","doi-asserted-by":"publisher","DOI":"10.1080\/13546783.2012.713178"},{"key":"e_1_2_6_46_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6947-12-94"},{"key":"e_1_2_6_47_1","unstructured":"Djulbegovic B.&Hozo I.(2010)Health Care Reform & Criteria for Rational Decision\u2010making. Available at:http:\/\/smdm.org\/uploads\/general_files\/SMDM_News_Spring_2010.pdf."},{"key":"e_1_2_6_48_1","doi-asserted-by":"publisher","DOI":"10.7326\/M14-1281"},{"key":"e_1_2_6_49_1","doi-asserted-by":"publisher","DOI":"10.7326\/M14-2820"}],"container-title":["Journal of Evaluation in Clinical Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fjep.12473","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fjep.12473","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jep.12473","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jep.12473","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jep.12473","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,11]],"date-time":"2023-09-11T01:34:10Z","timestamp":1694396050000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jep.12473"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,11,11]]},"references-count":48,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2017,4]]}},"alternative-id":["10.1111\/jep.12473"],"URL":"https:\/\/doi.org\/10.1111\/jep.12473","archive":["Portico"],"relation":{},"ISSN":["1356-1294","1365-2753"],"issn-type":[{"value":"1356-1294","type":"print"},{"value":"1365-2753","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,11,11]]}}}