USPSTF stance on statins for primary prevention of CVD varies by age, risk level
Click Here to Manage Email Alerts
The U.S. Preventive Services Task Force recommended statins for the primary prevention of CVD in patients aged 40 to 75 years with at least one CVD risk factor and 10% or greater 10-year risk for CVD.
The draft recommendation is consistent with the 2016 USPSTF recommendation statement on statins for primary CVD prevention.
“This is an opportunity to remind both health professionals and clinicians, as well as patients, that taking a statin can help prevent that first heart attack or stroke. Whether someone should take a statin largely depends on their age, risk factors and chances of having a first heart attack or stroke,” John B. Wong, MD, task force member and interim chief scientific officer, vice chair for academic affairs, chief of the Division of Clinical Decision Making, and a primary care clinician in the department of medicine at Tufts Medical Center, and a professor of medicine at Tufts University School of Medicine, told Healio. “For adults who are aged 40 to 75 years, who have at least one major risk factor and are at high risk for a first stroke or first heart attack, the evidence shows that they should take a statin. Now, those who are at increased but not high risk should speak with their health professionals and, together, decide if taking a statin is right for them.”
The updated draft recommendation is based on a review of 22 trials that reported on the benefits of statin use for primary prevention.
Grade B: Recommended
For adults aged 40 to 75 years with one or more CVD risk factors (dyslipidemia, diabetes, hypertension or smoking) and an estimated 10% or greater risk for 10-year CV event, a statin is recommended for primary prevention, the volunteer panel wrote.
Grade C: Depends on the patient’s situation
For adults aged 40 to 75 years, have one or more CVD risk factors and have an estimated 7.5% to 10% risk for 10-year CV event, selective prescription of a statin for primary prevention is recommended. The panel added that the likelihood of benefit in this population is less than in individuals with a 10% or more 10-year CV event risk.
Grade I: Indeterminate harms and benefits
For adults aged 76 years and older, there is insufficient evidence to establish a balance of benefit and harm of a statin for primary prevention, the volunteer panel wrote.
“The evidence is quite strong that statins can help prevent that first heart attack and first stroke. What’s important to remember is that one in four deaths in the U.S. is caused by CVD,” Wong told Healio. “If [patients are] at high risk, they should take a statin, based on the evidence. The benefits outweigh the harms. But if they’re at increased but not high risk, they ought to have a discussion with their trusted physician to see if taking a statin is right for them.”
CHD is the leading cause of death in the U.S., accounting for 43% of deaths attributable to CVD, the volunteer panel wrote. Researchers estimated that in 2019, there were 558,000 deaths attributable to CHD and 109,000 deaths from stroke.
In terms of future research needs, “One of the most important aspects is trying to improve the accuracy of CVD risk prediction; that is, prediction for all racial/ethnic and socioeconomic groups. We also need to learn more about the benefits and harms of statins in adults aged 75 years and older. We would like to learn about the effectiveness and safety of starting statins for people who are younger than 40 years and whether starting them earlier would have benefits,” Wong told Healio. “From an equity standpoint, we’d like to better understand the causes of disparities in statin use among different groups and how best to reduce that disparity. We’d like more research to definitively determine whether statin use increases the risk for diabetes. Lastly and importantly, we’d like to better understand the role of patient preference when it comes to decisions to prescribe statins in people across the risk of CVD spectrum.”
Reference:
- Task Force Issues Draft Recommendation Statement on Statin Use for the Primary Prevention of Cardiovascular Disease in Adults. https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/statin-use-cvd-prevention-draft-rec-bulletin.pdf. Published Feb. 22, 2022. Accessed Feb. 22, 2022.
Collapse
Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: U.S. Preventive Services Task Force Draft Recommendation Statement. Published and accessed Feb. 22, 2022.
Read more about
Click Here to Manage Email Alerts