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@MBittencourtMD @RonBlankstein @MichaelJBlaha @michael23ca @almallahmo @WilliamZoghbi @JACCJournals
Great results from the Polypill Iran study @TheLancet
Specially interested in those without clinical ASCVD
Results indicate 20% RRR with HR of 0·80 (95% C( 0·51–1·12)
NNT 21 https://twitter.com/vass_vassiliou/status/1164782996227936266
Great results from the Polypill Iran study @TheLancet
Specially interested in those without clinical ASCVD
Results indicate 20% RRR with HR of 0·80 (95% C( 0·51–1·12)
NNT 21 https://twitter.com/vass_vassiliou/status/1164782996227936266
# 2 @MBittencourtMD in 2014, using MESA data asked
-what is distribution of CAC among those meeting eligibility criteria for ongoing polypill clinical RCT's?
-whether potential 'estimated' benefit may apply all across subgroups by assessing outcomes in MESA for 5 years?
-what is distribution of CAC among those meeting eligibility criteria for ongoing polypill clinical RCT's?
-whether potential 'estimated' benefit may apply all across subgroups by assessing outcomes in MESA for 5 years?
#3, We showed that irrespective of the RCT criteria study, a significant proportion of those in MESA study eligible for polypill had CAC Zero
For the Poly Iran criteria, more than half had #PowerOfZero, 1 in 5 (18%) had significant CAC>100
For the Poly Iran criteria, more than half had #PowerOfZero, 1 in 5 (18%) had significant CAC>100
#4 In a 5 year FU in MESA (similar to the one conducted in the current RCT)
In CAC Zero CVD rates 2.5-4/1000 person year
Most of the events occurred in those with CAC>100 with CVD event rates 15.8 and 18.4 per 1,000 person-years.
See CVD KM curves for PolyIran criteria
In CAC Zero CVD rates 2.5-4/1000 person year
Most of the events occurred in those with CAC>100 with CVD event rates 15.8 and 18.4 per 1,000 person-years.
See CVD KM curves for PolyIran criteria
#5, Using a very high estimate of benefit 62%, which is 3 fold higher what we saw in the current clinical trial
we estimated NNT across CAC groups meeting eligibility for polypill
With these liberal benefit estimates NNT was suggested to be
-130 with CAC Zero
-20 with CAC>100
we estimated NNT across CAC groups meeting eligibility for polypill
With these liberal benefit estimates NNT was suggested to be
-130 with CAC Zero
-20 with CAC>100
#6 in a sensitivity analysis, where our lower estimate of benefit derived was 40% (twice of current study)
-NNT was >200 with 40% RRR estimate in CAC Zero
-NNT remained stably low across RRR estimates in CAC Zero
"Need Events to Reduce Events"-> Low benefit with#PowerOfZero
-NNT was >200 with 40% RRR estimate in CAC Zero
-NNT remained stably low across RRR estimates in CAC Zero
"Need Events to Reduce Events"-> Low benefit with#PowerOfZero
#7 William Wins wrote an intriguing editorial in @JACCJournals suggested
"This de-risking approach to risk reduction could be coined“interventional prevention.”
Worthwhile debating treat all approach vs potential selective use with higher CAC burden in without established CVD
"This de-risking approach to risk reduction could be coined“interventional prevention.”
Worthwhile debating treat all approach vs potential selective use with higher CAC burden in without established CVD
# 8 Based on the totality of evidence
-20% RRR with polypill in asymptomatic individuals age 50 & above
-Knowledge of nearly half may have no underlying CAC
-Extremely low CVD event with CAC Zero
Would u treat all irrespective of CAC or consider it prior to your consideration?
-20% RRR with polypill in asymptomatic individuals age 50 & above
-Knowledge of nearly half may have no underlying CAC
-Extremely low CVD event with CAC Zero
Would u treat all irrespective of CAC or consider it prior to your consideration?
# 8 Based on the totality of evidence
-20% RRR with polypill in asymptomatic individuals age 50 & above
-Knowledge of nearly half may have no underlying CAC
-Extremely low CVD event with CAC Zero
Would u treat all irrespective of CAC or consider it prior to your consideration?
-20% RRR with polypill in asymptomatic individuals age 50 & above
-Knowledge of nearly half may have no underlying CAC
-Extremely low CVD event with CAC Zero
Would u treat all irrespective of CAC or consider it prior to your consideration?
