Objective To systematically review current evidence regarding the minimum acceptable risk reduction of a cardiovascular event that patients feel would justify daily intake of a preventive medication.
Methods We used the Web of Science to track the forward and backward citations of a set of five key articles until 15 November 2016. Studies were eligible if they quantitatively assessed the minimum acceptable benefit—in absolute values—of a cardiovascular disease preventive medication among a sample of the general population and required participants to choose if they would consider taking the medication.
Results Of 341 studies screened, we included 22, involving a total of 17 751 participants: 6 studied prolongation of life (POL), 12 studied absolute risk reduction (ARR) and 14 studied number needed to treat (NNT) as measures of risk reduction communicated to the patients. In studies framed using POL, 39%–54% (average: 48%) of participants would consider taking a medication if it prolonged life by <8 months and 56%–73% (average: 64%) if it prolonged life by ≥8 months. In studies framed using ARR, 42%–72% (average: 54%) of participants would consider taking a medication that reduces their 5-year cardiovascular disease (CVD) risk by <3% and 50%–89% (average: 77%) would consider taking a medication that reduces their 5-year CVD risk by ≥3%. In studies framed using 5-year NNT, 31%–81% (average: 60%) of participants would consider taking a medication with an NNT of >30 and 46%–87% (average: 71%) with an NNT of ≤30.
Conclusions Many patients require a substantial risk reduction before they consider taking a daily medication worthwhile, even when the medication is described as being side effect free and costless.
- Cardiovascular Diseases
- Risk Assessment
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Twitter Follow Loai Albarqouni at @lnb6des, and Jenny Doust at @jadoust, and Paul Glasziou at @paulglasziou.
Contributors LA, JD and PG designed the study. LA, JD and PG screened the articles. LA, JD and PG extracted data. LA drafted the original manuscript, and all authors revised the paper. LA is the guarantor of the study.
Competing interests All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: Dr Glasziou reports grants from National Heart Foundation prior to the conduct of this study. No support from any organisation for the submitted work; no other relationships or activities that could appear to have influenced the submitted work.
Patient consent This study is a systematic review, hence, no direct involvement of human subjects.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data extracted from the included studies are available on request from the corresponding author.