| アブストラクト | OBJECTIVES: The study aims to explore the use of regression discontinuity analysis (RDA) to examine effects of prescription of statins on total cholesterol and adverse outcomes (type 2 diabetes, rhabdomyolysis and myopathy, myalgia and myositis, liver disease, CVD, and mortality). STUDY DESIGN AND SETTING: We conducted a prospective cohort study using the Clinical Practice Research Datalink including patients with QRISK scores of 10 to 30 in 2010 to 2013 who were last followed-up in October 2016. Comparing patients with QRISK>/=20 and QRISK<20, we explored RDA assumptions, provided proof of concept analyses (total cholesterol as outcome), and investigated the effect of statins prescription on adverse outcomes. RESULT: RDA confirmed statin prescription reduced total cholesterol (Mean difference (MD) -1.33 mmol/L, 95%Confidence Interval (CI) -1.93 to -0.73). RDA provided little evidence for adverse effects on diabetes, myalgia and myositis, liver disease, CVD, or mortality. The RDA analysis findings are similar to RCT results. Findings from non-RDA analysis agree with published observational studies. CONCLUSION: RDA can be used with large routine clinical datasets to provide evidence on effects of medications which are prescribed according to a threshold. Testable RDA assumptions were satisfied, but confidence intervals were wide, partly due to the low compliance with the prescribing threshold. |
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| 組織名 | National Institute for Health Research Applied Research Collaboration West,;University Hospitals Bristol and Weston NHS Foundation Trust, 9th Floor,;Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK; Population Health Sciences,;Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road,;Bristol, BS8 2PS, UK.;Bristol, BS8 2PS, UK. Electronic address: theresa.redaniel@bristol.ac.uk.;Centre for Academic Primary Care, Bristol Medical School, Canynge Hall,;University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK.;Bristol, BS8 2PS, UK; MRC Integrative Epidemiology Unit, Bristol Medical School,;Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK. |
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