American journal of preventive cardiology · 2026
Factors associated with patient preferences for statin therapy in primary prevention.
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Luo Yan, Kawakami Hiroshi, Funada Satoshi, Ozawa Shoma, Sahker Ethan, Omae Kenji, Yamamoto Kazumichi, Yamaguchi Osamu, Tajika Aran, Furukawa Toshi A
Аннотация
INTRODUCTION: The smallest worthwhile difference (SWD) - the minimum absolute benefit required to justify a treatment against its burdens - varies by personal preference. We investigated factors associated with SWD variation for statin therapy in primary prevention of atherosclerotic cardiovascular disease (ASCVD) to inform shared decision-making strategies.
METHODS: This pre-planned secondary analysis used survey data from the US (n = 602) and Japan (n = 665). Participants determined their SWD for statins across three 10-year ASCVD risk scenarios (2%, 10%, 20%) using the Benefit-Harm Trade-off Method. Subgroup analyses compared SWD by statin use history, self-perceived baseline risk, and hypercholesterolemia diagnosis. Associations between participant characteristics and SWD were examined using proportional odds regression adjusted for age and sex. A post hoc analysis using a directed acyclic graph explored the causal role of prior cholesterol education.
RESULTS: The median SWD exceeded the benefits typically provided by statins across all scenarios. Predictors of lower SWDs (greater willingness to initiate statins) were mostly consistent across countries. Higher self-perceived ASCVD risk was associated with lower SWD: in the moderate-risk scenario, median SWDs decreased from 7.5-10.0% to 2.5-5.0% as self-perceived risk increased. Current statin use, hypercholesterolemia history, and cardiovascular comorbidities were each associated with lower SWDs. After adjusting for confounders, prior cholesterol education was associated with 38% (US) and 47% (Japan) lower odds of selecting a higher SWD (OR 0.62 [95%CI 0.42-0.90] and 0.53 [0.31-0.90], respectively), indicating lower treatment efficacy expectations.
CONCLUSIONS: Risk perception and understanding of treatment benefits may predict statin acceptance. Educational interventions strengthening treatment-specific knowledge may represent a promising strategy to align patient preferences with clinical evidence.
METHODS: This pre-planned secondary analysis used survey data from the US (n = 602) and Japan (n = 665). Participants determined their SWD for statins across three 10-year ASCVD risk scenarios (2%, 10%, 20%) using the Benefit-Harm Trade-off Method. Subgroup analyses compared SWD by statin use history, self-perceived baseline risk, and hypercholesterolemia diagnosis. Associations between participant characteristics and SWD were examined using proportional odds regression adjusted for age and sex. A post hoc analysis using a directed acyclic graph explored the causal role of prior cholesterol education.
RESULTS: The median SWD exceeded the benefits typically provided by statins across all scenarios. Predictors of lower SWDs (greater willingness to initiate statins) were mostly consistent across countries. Higher self-perceived ASCVD risk was associated with lower SWD: in the moderate-risk scenario, median SWDs decreased from 7.5-10.0% to 2.5-5.0% as self-perceived risk increased. Current statin use, hypercholesterolemia history, and cardiovascular comorbidities were each associated with lower SWDs. After adjusting for confounders, prior cholesterol education was associated with 38% (US) and 47% (Japan) lower odds of selecting a higher SWD (OR 0.62 [95%CI 0.42-0.90] and 0.53 [0.31-0.90], respectively), indicating lower treatment efficacy expectations.
CONCLUSIONS: Risk perception and understanding of treatment benefits may predict statin acceptance. Educational interventions strengthening treatment-specific knowledge may represent a promising strategy to align patient preferences with clinical evidence.