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The effect of statins on average survival in randomised trials, an analysis of end point postponement
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  • Published on:
    Re: The effect of statins on average survival in randomized trials, an analysis of end point postponement
    • Jodell Smith, student The University of the Bahamas
    • Other Contributors:
      • Terry J Campbell, Lecturer

    Dear Editor:
    This response is in relation to your article. I found this article useful in many different ways for example, the number needed to treat (NNT) systems. I also gained the knowledge of primary and secondary prevention trials. What amazed me though was that the number were so small being that the “highest value was 27 days according to the 4S study.
    While I understand that patients have the right to refuse treatment, I did not expect 70% of individuals to decline. It was good to note that although the survival time was only implemented during the running time of the study, a few follow up trials were done, regardless of the mortality rate discovered. Although, according to Benner et al., (2002), “despite slightly better persistence among patients who began treatment in recent years, long-term use remains low”, the efforts made to research this drug is amazing. The idea of a hybrid model of classical NNT thinking along with a postponement model sounds interesting and effective.
    The focus of your study including all-cause mortality was an unbiased study. What grasped my attention the most was that you realized your mistake, admitted your mistake, made corrections, and apologized for the inconvenienced caused. Thanks for indicating that statins are inexpensive when used in the clinical settings and I agree that if the patient has intolerance or unpleased side effects from statins, it should not be forced upon them. The use of postp...

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    Conflict of Interest:
    None declared.
  • Published on:
    Do Statins only postpone death by three or four days?

    Kristensen et al. report results from a meta-analysis of statin trials on years of life gained published in BMJ Open in 2015 (1). The authors conclude that death was postponed between -5 and 19 days in primary and between -10 and 27 days in secondary prevention trials. The paper has been widely quoted in newspapers under headlines such as "Statins are NOT a magic bullet for longer life" and "Statins may only postpone de...

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    Conflict of Interest:
    None declared.
  • Published on:
    Error in median values
    • Jesper Hallas, Professor
    • Other Contributors:
      • Malene Lopez Kristensen, Palle Mark Christensen

    One reader has notified us about an error in our manuscript regarding the calculated median values for postponement of death in secondary prevention trials. These errors have no implications for the conclusions or the discussion of the study.

    In the abstract line 16 p.1 "and secondary prevention trials were 3.2 and 4.1 days," The correct line is "and secondary prevention trials were 5,8 and 4,1 days,"

    In...

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    Conflict of Interest:
    None declared.
  • Published on:
    Re:The effect of statins on average survival - revisited
    • Jesper Hallas, Professor
    • Other Contributors:
      • Malene Lopez Kristensen, Palle Mark Christensen

    We can hardly disagree about the limitations pointed out by Dr Chang et al and by Roger Marshall. We emphasized in the discussion section that the postponements (or increment in restricted mean survival) calculated by us were restricted to the trials' running time, usually in the order of 5 years. We fully agree - and have emphasized in our paper - that they do not answer the question on what would be the benefit from a l...

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    Conflict of Interest:
    None declared.
  • Published on:
    The effect of statins on average survival - revisited
    • Shu-Ching Chang, Biostatistician
    • Other Contributors:
      • Mansen Wang, James G. Beckerman, Mark Sanz, Ty J. Gluckman, Gary L. Grunkemeier

    The recent paper by Kristensen et al. [1] examined 11 randomized clinical trials (RCTs) of statins and concluded that they provide "a surprisingly small average gain in overall survival within the trials' running time", and that "The median postponement of death for primary and secondary prevention trials were 3.2 and 4.1 days, respectively."

    This appears to question the value of statins, yet the information a...

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    Conflict of Interest:
    None declared.
  • Published on:
    Assessing postponement time

    Kristensen et al [1] have estimated "postponement" of death in trials due to statins. Their finding is that postponement is measured in days - median pooled 3 to 4 days - which suggests statins have scarcely any benefit. It may well be that their benefits are, indeed, minimal, but the point of this note is not to question efficacy of statins, rather it is to suggest that the statistical analysis presented in this study...

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    Conflict of Interest:
    None declared.