Trial duration. You need >5 years for enough power for ACM. 4S: 5.4 yrs IDEAL: 4.8 yrs CARDS: 3.9 yrs ASPEN: 4 yrs JUPITER: 1.9 yrs IMPROVE-IT: 6 yrs FOURIER: 2.2 yrs The reason IMPROVE-IT doesn't see the effect is because subjects already achieved good LDL targets at baseline.
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Replying to @The_Nutrivore @waseemkiani and
This figure from the Cooper Longitudinal Study really demonstrates the importance of duration with respect to all-cause mortality, considering any change should be driven by a reduction in CVD deaths. https://pubmed.ncbi.nlm.nih.gov/30571575/ pic.twitter.com/fhhi0Mj0TK
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Replying to @MattMadore576 @waseemkiani and
Are you aware of any data like this specifically looking at ACM?
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Replying to @The_Nutrivore @waseemkiani and
4S has a Kaplan-Meier curve for ACM, but I can't think of one stratified by achieved LDL like this off the top of my head.
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Replying to @The_Nutrivore @waseemkiani and
Theirs looks like this with a reduction from ~184 mg/dL mean LDL to ~120 mg/dLpic.twitter.com/hk3YSoylO4
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Replying to @MattMadore576 @waseemkiani and
I should plug this isn't to RevMan and see where the differences become significant.
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Replying to @The_Nutrivore @waseemkiani and
Another one for ACM from long-term WOSCOPS follow-up. The achieved reduction in the intervention during the initial trial (~5 years) was from ~190 mg/dL to ~140 mg/dL, statin use was only recorded for the first 10 years. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.115.018791 …pic.twitter.com/sC4zsFfyvy
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Replying to @The_Nutrivore @waseemkiani and
Perfectly exemplifies how the magnitude in reduction of LDL can alter the duration needed to see an effect
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I think I need to mute this thread, as the notifications are getting out of hand.
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