Statins in primary prevention – 2016


During the past few years the use of statins in primary prevention has come under scrutiny. In 2015  the UK chief medical officer asked the Academy of Medical Sciences to review of drug evaluation in wake of statins controversy [Ref]. The current recommendations from the US Preventive Services Task Force [link] is given below.  In addition the ALLHAT  RCT reports the ‘Effect of Statin Treatment vs Usual Care on Primary Cardiovascular Prevention Among Older Adults’ [Ref].  If you prefer some concise evidence based recommendations from a family practice journal the AFP article would be helpful [Ref] 

UPSTAF recommendations 2016

The USPSTF reviewed the evidence on the benefits and harms of screening for and treatment of dyslipidemia in adults 21 years and older, i.e.the benefits and harms of statin use in reducing CVD events and mortality in adults without a history of CVD events.

It reviewed 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. More….

Conclusions and Recommendations

The 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).

To determine whether a patient is a candidate for statin therapy, clinicians must first determine the patient’s risk of having a future CVD event. However, clinicians’ ability to accurately identify a patient’s true risk is imperfect, because the best currently available risk estimation tool, which uses the Pooled Cohort Equations from the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines on the assessment of cardiovascular risk,1 has been shown to overestimate actual risk in multiple external validation cohorts.2-4 The reasons for this possible overestimation are still unclear.

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