Centre for Research in Evidence-Based Practice (CREBP), Bond University, Gold Coast, Australia.
Heart. 2017 Oct;103(20):1578-1586. doi: 10.1136/heartjnl-2017-311244. Epub 2017 May 13.
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.
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.
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.
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.
系统评价患者认为每日服用预防药物值得接受的心血管事件最低可接受风险降低程度的现有证据。
我们使用 Web of Science 跟踪了一组 5 篇关键文章的前向和后向引文，直到 2016 年 11 月 15 日。如果研究定量评估了一般人群样本中某种心血管疾病预防药物的最低可接受获益（绝对值），并要求参与者选择是否考虑服用该药物，则该研究符合纳入标准。
在筛选出的 341 项研究中，我们纳入了 22 项研究，共涉及 17751 名参与者：6 项研究探讨了延长寿命（POL），12 项研究探讨了绝对风险降低（ARR），14 项研究探讨了需要治疗的人数（NNT）作为向患者传达的风险降低措施。在使用 POL 进行框架研究中，如果药物可以延长寿命<8 个月，有 39%-54%（平均：48%）的参与者会考虑服用药物；如果药物可以延长寿命≥8 个月，有 56%-73%（平均：64%）的参与者会考虑服用药物。在使用 ARR 进行框架研究中，如果药物可以降低参与者 5 年内的心血管疾病（CVD）风险<3%，有 42%-72%（平均：54%）的参与者会考虑服用药物；如果药物可以降低参与者 5 年内的 CVD 风险≥3%，有 50%-89%（平均：77%）的参与者会考虑服用药物。在使用 5 年 NNT 进行框架研究中，如果药物的 NNT>30，有 31%-81%（平均：60%）的参与者会考虑服用药物；如果药物的 NNT≤30，有 46%-87%（平均：71%）的参与者会考虑服用药物。
即使药物被描述为无副作用且免费，许多患者仍需要大量的风险降低，才会认为每日服用药物是值得的。
