TEC: Evidence Based Therapeutics
Therapeutics Education Collaboration
Medication Mythbusters – Home of the Best Science (BS) Medicine Podcast

Episode 4: De-constructing Risk (or Benefit)

In our fourth installment, we apply the absolute benefit for statin therapy to our patient. We discuss the absolute benefits in context of the individual risk and acknowledge that when translating pooled literature numbers to individual patients an element of mysterious uncertainty always remains (except for James who knows but won’t tell and Mike who doesn’t know but tells us he does).

Show Notes

Definitions

CVD is cardiovascular disease and typically refers to the combination of CHD (coronary heart disease – fatal and non-fatal MIs and sometimes angina) PLUS cerebrovascular disease (fatal and non-fatal strokes – and sometimes TIAs) PLUS (sometimes) other conditions (heart failure, peripheral vascular disease)

Calculating benefit

  1. Change the factor and recalculate the chance of CVD
  2. Use the relative benefits seen in clinical trials (typically 5 years in duration) and apply them to the chance calculated for your patient
  3. Avoid the use of CDV calculators and just use the absolute benefits seen in clinical trials

A synopsis of the relative benefit of drugs

  • Statins ? 30%? in CHD (0%? in women)? 5 years
  • BP ? 40 %? in strokes and ? 20%? in CHD ? 5 years
  • Metformin ? 35%? in CHD and stroke ? 8-10 years

A synopsis of the absolute benefit of drugs

Statins over 5 years in a post MI patient Coronary events ?4% (15% to 11%) Death ?2% (12% to 10%) Strokes ?1% (5% to 4%) Treating a Blood Pressure of 160 /100 mmHg for 5 years CVD ? 1% (4% to 3%)

Absolute benefit of statins over approx 5 years

Major coronary events (%)* Death (%) Strokes (%) FROM WHAT CVD TO WHAT CVD (%)
Primary 1-1.5* 8-9 to 7
Diabetes 2 1-1.5 10 to 7
Secondary 4 2 1 20 to 15

* just in males and NO difference in overall serious adverse events

Listening to this episode is for premium podcast members only. If you already have a membership, login to your account. If you aren't yet a premium subscriber, sign up today!

Search

BS Medicine Podcast

The 2024 MEME Conference – May 24-25, 2024

REGISTRATION COMING SOON

Making Evidence Matter For Everyone | May 24 & 25, 2024
From the clinicians who brought you the Best Science Medicine Course and the Meds Conference, as well as the BS Medicine Podcast and Tools for Practice

hectalks.com

BIG ANNOUNCEMENT

THE NUTRITION PROPOSITION BOOK

Check it out at nutritionproposition.com and think about picking up a copy on Amazon. All the evidence you ever wanted about nutrition and the only nutrition book that won’t tell you what to eat.

 

BedMed: The High Blood Pressure Study

This pragmatic trial is now recruiting in BC. Make a difference and get involved with pragmatic trials (www.pragmatictrials.ca)

PEER Tools

Search

Recent Posts

Archives

Categories

Meta