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Should identical CVD risks in young and old patients be managed identically? results from two models

OBJECTIVES: To assess whether delaying risk reduction treatment has a different impact on potential life years lost in younger compared with older patients at the same baseline short-term cardiovascular risk. DESIGN: Modelling based on population data. METHODS: Potential years of life lost from...

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Main Authors: Liew, S.M., Jackson, R., Mant, D., Glasziou, P.
Format: Article
Language:English
Published: BMJ Publishing Group 2012
Subjects:
R Medicine
Online Access:http://eprints.um.edu.my/2919/1/3.pdf
http://eprints.um.edu.my/2919/
http://www.ncbi.nlm.nih.gov/pubmed/22382122
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spelling my.um.eprints.29192019-09-26T03:03:01Z http://eprints.um.edu.my/2919/ Should identical CVD risks in young and old patients be managed identically? results from two models Liew, S.M. Jackson, R. Mant, D. Glasziou, P. R Medicine OBJECTIVES: To assess whether delaying risk reduction treatment has a different impact on potential life years lost in younger compared with older patients at the same baseline short-term cardiovascular risk. DESIGN: Modelling based on population data. METHODS: Potential years of life lost from a 5-year treatment delay were estimated for patients of different ages but with the same cardiovascular risk (either 5% or 10% 5-year risk). Two models were used: an age-based residual life expectancy model and a Markov simulation model. Age-specific case fatality rates and time preferences were applied to both models, and competing mortality risks were incorporated into the Markov model. RESULTS: Younger patients had more potential life years to lose if untreated, but the maximum difference between 35 and 85 years was <1 year, when models were unadjusted for time preferences or competing risk. When these adjusters were included, the maximum difference fell to about 1 month, although the direction was reversed with older people having more to lose. CONCLUSIONS: Surprisingly, age at onset of treatment has little impact on the likely benefits of interventions that reduce cardiovascular risk because of the opposing effects of life expectancy, case fatality, time preferences and competing risks. These findings challenge the appropriateness of recommendations to use lower risk-based treatment thresholds in younger patients. BMJ Publishing Group 2012 Article PeerReviewed application/pdf en http://eprints.um.edu.my/2919/1/3.pdf Liew, S.M. and Jackson, R. and Mant, D. and Glasziou, P. (2012) Should identical CVD risks in young and old patients be managed identically? results from two models. BMJ Open, 2 (2). ISSN 2044-6055 http://www.ncbi.nlm.nih.gov/pubmed/22382122 22382122
institution Universiti Malaya
building UM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaya
content_source UM Research Repository
url_provider http://eprints.um.edu.my/
language English
topic R Medicine
spellingShingle R Medicine
Liew, S.M.
Jackson, R.
Mant, D.
Glasziou, P.
Should identical CVD risks in young and old patients be managed identically? results from two models
description OBJECTIVES: To assess whether delaying risk reduction treatment has a different impact on potential life years lost in younger compared with older patients at the same baseline short-term cardiovascular risk. DESIGN: Modelling based on population data. METHODS: Potential years of life lost from a 5-year treatment delay were estimated for patients of different ages but with the same cardiovascular risk (either 5% or 10% 5-year risk). Two models were used: an age-based residual life expectancy model and a Markov simulation model. Age-specific case fatality rates and time preferences were applied to both models, and competing mortality risks were incorporated into the Markov model. RESULTS: Younger patients had more potential life years to lose if untreated, but the maximum difference between 35 and 85 years was <1 year, when models were unadjusted for time preferences or competing risk. When these adjusters were included, the maximum difference fell to about 1 month, although the direction was reversed with older people having more to lose. CONCLUSIONS: Surprisingly, age at onset of treatment has little impact on the likely benefits of interventions that reduce cardiovascular risk because of the opposing effects of life expectancy, case fatality, time preferences and competing risks. These findings challenge the appropriateness of recommendations to use lower risk-based treatment thresholds in younger patients.
format Article
author Liew, S.M.
Jackson, R.
Mant, D.
Glasziou, P.
author_facet Liew, S.M.
Jackson, R.
Mant, D.
Glasziou, P.
author_sort Liew, S.M.
title Should identical CVD risks in young and old patients be managed identically? results from two models
title_short Should identical CVD risks in young and old patients be managed identically? results from two models
title_full Should identical CVD risks in young and old patients be managed identically? results from two models
title_fullStr Should identical CVD risks in young and old patients be managed identically? results from two models
title_full_unstemmed Should identical CVD risks in young and old patients be managed identically? results from two models
title_sort should identical cvd risks in young and old patients be managed identically? results from two models
publisher BMJ Publishing Group
publishDate 2012
url http://eprints.um.edu.my/2919/1/3.pdf
http://eprints.um.edu.my/2919/
http://www.ncbi.nlm.nih.gov/pubmed/22382122
_version_ 1646210105864093696
score 13.211869

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