USPSTF: Statin Use for Primary Prevention of Cardiovascular Disease

The U.S. Preventive Services Task Force (USPSTF) has published a final recommendation statement on the use of statins for primary prevention of cardiovascular disease (CVD) in adults. This recommendation replaces the one from 2008 on screening for lipid disorders in adults.

Specifically, USPSTF reviewed available evidence for:

• Benefits and harms of screening for and treating dyslipdemia in patients 21 years of age and older
• Benefits and harms of statin use in reducing CVD events and death in adults without a history of CVD
• Benefits of statin use by subgroup, clinical characteristics, or dosage
• Benefits of various treatment strategies in patients over 40 years old without a history of CVD

Based on this data, the following recommendations were issued:

• For adults 40–75 years old with no history of CVD, 1 or more CVD risk factors, and a calculated 10-year CVD event risk of 10% or greater: use low- to moderate-dose statin for prevention of CVD events and mortality (Grade B [recommended])
• For adults 40–75 years old with no history of CVD, 1 or more CVD risk factors, and a calculated 10-year CVD event risk of 7.5%–10%: clinicians may choose to offer a low- to moderate-dose statin in certain patients; likelihood of benefit is smaller in this group, as the probability of disease is lower and there is uncertainty in individual risk prediction (Grade C [recommendation depends on patient’s situation])
• For adults 76 years and older with no history of CVD: current evidence is insufficient to assess the benefits/harms of initiating statins for primary prevention and CVD events and mortality (Grade I [balance of benefits and harms cannot be determined])

“People with no signs, symptoms, or history of cardiovascular disease can still be at risk for having a heart attack or stroke. Fortunately, statins can be a very effective way to help some people between 40 and 75 years old to reduce this risk,” said Task Force chair Kirsten Bibbins-Domingo, Ph.D., M.D., M.A.S.

As far as the risks associated with initiating statin therapy, the USPSTF found adequate evidence that for patients aged 40–75 years, the potential for harm was small with low- to moderate-statin use; however, evidence on the harms associated with starting statins in patients 76 years and older without a history of CVD was found to be inadequate.

The USPSTF also notes the lack of evidence available on screening and treating patients between the ages of 20 and 39 years old; more research is needed in this patient population including studies on long-term statin use as well as assessing the effects of early versus delayed initiation of statin therapy, particularly in patients with elevated lipid levels (ie, familial hypercholesterolemia).

To read the full recommendation statement visit USPSTF.org.