Re: Factors Associated with Findings of Published Trials of Drug-Drug Comparisons: Why Some Statins Appear More Efficacious than Others

On Jun 9, 4:08 pm, MarilynMann <m...@xxxxxxxxxxx> wrote:


"In a multiple Cox regression model, we assessed the effects of single
risk factors adjusted for all other covariables that were
significantly associated with CVD in univariate analysis. . . In
women, year of birth, HDL-C, lipoprotein(a) and homocysteine levels
were independent predictors of an increased risk of CVD and 15.9% of
the variation in CVD risk could be explained by these risk factors."

This is just a statement of how they decided what variables to use in a
model predicting CVD risk. They used a pretty standard method. As you
note, lots of the variation in risk is not explained by the model.

In the model for men with FH, year of birth, smoking and hypertension
were associated independently with CVD and explained 20.7% of the
variation in risk.

It is worth noting that during 53,071 patient-years, 41.2% of the men
with FH had their first cardiovascular event. In 59,891 patient-
years, 24.1% of the women had their first cardiovascular event. In
the subgroup with CVD, the mean age of onset was 45.9 in men and 52.5
in women. The study was conducted between 1989 and 2002.



In other words, for a person with FH, there is a rebuttable
presumption that they are at risk for early heart disease and need to
be treated with statins. Currently, we do not know how to rebut that
presumption.

Many are also on non-statins, but let's not get into that . . .

presumption: a rule of law which requires the assumption of fact from
another fact or set of facts.

rebuttable presumption: an ordinary presumption that must, as a
matter of law, be made once certain facts have been proved, and which
is thus said to establish a prima facie conclusion; it may be rebutted
or overcome through the introduction of contrary evidence, but if it
is not, it becomes conclusive. After rebutting evidence is
introduced, under prevailing doctrine the competing facts are weighed
on their own merits, without further reference to the presumption.

prima facie: not requiring further support to establish existence,
validity, credibility, etc.

Marilyn

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