Iranian general populations' and health care providers' preferences for benefits and harms of statin therapy for primary prevention of cardiovascular disease

Hassan Saadati, Hamid Reza Baradaran*, Goodarz Danaei, Afshin Ostovar, Farzad Hadaegh, Leila Janani, Ewout W. Steyerberg, Davood Khalili

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Background: The use of statins for primary prevention of cardiovascular diseases is associated with different benefit and harm outcomes. The aime of this study is how important these outcomes are for people and what people's preferences are. Methods: We conducted a preference-eliciting survey incorporating a best–worst scaling (BWS) instrument in Iran from June to November 2019. The relative importance of 13 statins-related outcomes was assessed on a sample of 1085 participants, including 913 general population (486 women) and 172 healthcare providers from the population covered by urban and rural primary health care centers. The participants made trade-off decisions and selected the most and least worrisome outcomes concurrently from 13 choice sets; each contains four outcomes generated using the balanced incomplete block design. Results: According to the mean (SD) BWS scores, which can be (+ 4) in maximum and (− 4) in minimum, in the general population, the most worrisome outcomes were severe stroke (3.37 (0.8)), severe myocardial infarction (2.71(0.7)), and cancer (2.69 (1.33)). While myopathy (− 3. 03 (1.03)), nausea/headache (− 2.69 (0.94)), and treatment discontinuation due to side effects (− 2.24 (1.14)) were the least worrisome outcomes. Preferences were similar between rural and urban areas and among health care providers and the general population with overlapping uncertainty intervals. Conclusion: The rank of health outcomes may be similar in various socio-cultural contexts. The preferences for benefits and harms of statin therapy are essential to assess benefit-harm balance when recommending statins for primary prevention of cardiovascular diseases.

Original languageEnglish
Article number288
Number of pages11
JournalBMC Medical Informatics and Decision Making
Publication statusPublished - 4 Nov 2020

Bibliographical note


This study was conducted at the Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences Tehran, Iran. Lown Scholar Program of the Harvard T.H. Chan School of Public Health helped in funding and designing the study. We thank the respectful staff of the Non-Communicable Diseases Office of the Ministry of Health and Medical Education in Iran for their help and advice on developing the survey. We gratefully thank Prof. MA Puhan for sharing their experience on the design and implementation of best-worst scaling.


This study is a part of a project funded by the National Institute of Medical Research. Development (NIMAD) (Grant No. 964114) and was supported by the Iran University of Medical. Sciences. The funding bodies had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.


  • Benefit harm outcomes
  • Cardiovascular disease
  • Preferences
  • Primary prevention
  • Statins


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