A statin a day keeps the doctor away: comparative proverb assessment modelling study
BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f7267 (Published 17 December 2013) Cite this as: BMJ 2013;347:f7267
- Adam D M Briggs, academic clinical fellow,
- Anja Mizdrak, researcher,
- Peter Scarborough, senior researcher
- 1BHF Health Promotion Research Group, Nuffield Department of Population Health, University of Oxford, Headington, Oxford OX3 7LF, UK
- Correspondence to: A D M Briggs adam.briggs{at}dph.ox.ac.uk
- Accepted 27 November 2013
Abstract
Objective To model the effect on UK vascular mortality of all adults over 50 years old being prescribed either a statin or an apple a day.
Design Comparative proverb assessment modelling study.
Setting United Kingdom.
Population Adults aged over 50 years.
Intervention Either a statin a day for people not already taking a statin or an apple a day for everyone, assuming 70% compliance and no change in calorie consumption. The modelling used routinely available UK population datasets; parameters describing the relations between statins, apples, and health were derived from meta-analyses.
Main outcome measure Mortality due to vascular disease.
Results The estimated annual reduction in deaths from vascular disease of a statin a day, assuming 70% compliance and a reduction in vascular mortality of 12% (95% confidence interval 9% to 16%) per 1.0 mmol/L reduction in low density lipoprotein cholesterol, is 9400 (7000 to 12 500). The equivalent reduction from an apple a day, modelled using the PRIME model (assuming an apple weighs 100 g and that overall calorie consumption remains constant) is 8500 (95% credible interval 6200 to 10 800).
Conclusions Both nutritional and pharmaceutical approaches to the prevention of vascular disease may have the potential to reduce UK mortality significantly. With similar reductions in mortality, a 150 year old health promotion message is able to match modern medicine and is likely to have fewer side effects.
Footnotes
We acknowledge Lennert Veerman for his contribution to suggestions regarding the modelling of adverse events.
Contributors: ADMB devised a different study involving superheroes; PS expanded the idea and wanted to do that one. ADMB instead devised this study and talked PS out of the other one. Therefore, for this study, PS developed the PRIME model. ADMB and AM completed the modelling, and ADMB drafted the manuscript. ADMB and PS contributed to the study design. ADMB, PS, and AM reviewed and critiqued the final manuscript. PS will have to wait until next year to write a paper about superheroes. ADMB is unlikely to help him, but AM could be talked around to the idea. ADMB is the guarantor.
Funding: No explicit funding for this work was sought. ADMB is a National Institute for Health Research funded academic clinical fellow in public health. PS and AM are funded by the British Heart Foundation. The funders had no role in the design, process, or reporting of this study.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; PS has received research grants from the British Heart Foundation; ADMB eats five a day, AM tries to, and PS is a vegetarian; all diets include apples; neither ADMB, AM, nor PS takes statins, and all purport to be under 50 years old.
Ethical approval: This study used routinely collected publicly available datasets; ethics approval was not needed.
Transparency declaration: The lead author (the manuscript’s guarantor) affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.
Data sharing: All data used in this study are freely available secondary data sets.
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