Statin Use for the Primary Prevention of Cardiovascular Disease in Adults

Abstract

IMPORTANCE Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the United States, accounting for 1 of every 3 deaths among adults.OBJECTIVE To update the 2008 US Preventive Services Task Force (USPSTF) recommendation on screening for lipid disorders in adults. EVIDENCE REVIEWThe USPSTF reviewed the evidence on the benefits and harms of screening for and treatment of dyslipidemia in adults 21 years and older; the benefits and harms of statin use in reducing CVD events and mortality in adults without a history of CVD events; whether the benefits of statin use vary by subgroup, clinical characteristics, or dosage; and the benefits of various treatment strategies in adults 40 years and older without a history of CVD events. CONCLUSIONS AND RECOMMENDATIONSThe USPSTF recommends initiating use of low-to moderate-dose statins in adults aged 40 to 75 years without a history of CVD who have 1 or more CVD risk factors (dyslipidemia, diabetes, hypertension, or smoking) and a calculated 10-year CVD event risk of 10% or greater (B recommendation). The USPSTF recommends that clinicians selectively offer low-to moderate-dose statins to adults aged 40 to 75 years without a history of CVD who have 1 or more CVD risk factors and a calculated 10-year CVD event risk of 7.5% to 10% (C recommendation). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of initiating statin use in adults 76 years and older (I statement).

Association Between Statin Use and Cardiovascular Events After Carotid Artery Revascularization

“…Systematic reviews and meta‐analyses of patients undergoing cardiac surgery46 and abdominal aortic aneurysm repair47 have also reported similar associations with lower rates of periprocedural events in statin users. Finally, high‐quality multicenter randomized controlled trials of general populations at risk for cardiovascular events indicate that statin therapy is associated with a 20% to 30% reduction in long‐term cardiovascular event rates 48, 49. We observed similar reductions in rates of 5‐year events after carotid revascularization among statin users.…”

Statin Eligibility, Coronary Artery Calcium, and Subsequent Cardiovascular Events According to the 2016 United States Preventive Services Task Force (USPSTF) Statin Guidelines: MESA (Multi‐Ethnic Study of Atherosclerosis)

“…Traditional ASCVD risk factors were identified based on definitions used by the USPSTF guidelines 1. Hypertension was defined as a systolic blood pressure ≥140 mm Hg, or a diastolic blood pressure ≥90 mm Hg, or antihypertensive medication use.…”

“…In 2016, the United States Preventive Services Task Force (USPSTF) released guidelines on statin use for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) 1. These guidelines recommended that individuals aged 40 to 75 years with 1 or more major ASCVD risk factors (hypertension, tobacco use, diabetes mellitus, or dyslipidemia) and a 10‐year ASCVD risk ≥10% initiate statin therapy.…”

Effectiveness of Statins as Primary Prevention in People With Different Cardiovascular Risk: A Population‐Based Cohort Study

“…New guidelines to manage dyslipidemia recommend individualized prevention measures to reduce the incidence of cardiovascular events and focus on two benefit groups: first, secondary prevention patients, diabetics, and patients with one or more cardiovascular risk factors (dyslipidemia, hypertension, or smoking) or with chronic kidney disease; and second, individuals with 10‐year cardiovascular risk estimates 1, 2, 3, 4. These guidelines have lowered the estimated 10‐year cardiovascular risk threshold to reduce the incidence of cardiovascular events.…”

“…In primary prevention, European guidelines recommend treatment in individuals with 5% or higher risk on the SCORE 10‐year fatal cardiovascular risk chart and in those with low (<5%) risk and low‐density lipoprotein (LDL) cholesterol levels between 2.6 and 4 mmol/L 4. US guidelines recommend treatment for individuals aged 40–75 years with 10‐year risk scores 7.5%; each guide, however, with different levels of evidence 1, 2. In the United Kingdom, the National Institute for Health and Care Excellence suggests statin treatment in primary prevention for people with 10% risk 3.…”