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USPSTF Recommends Statin Use for Primary Prevention of Cardiovascular Disease in Some Adults
The U.S. Preventive Services Task Force (USPSTF) has released a final recommendation statement on statin use for the primary prevention of cardiovascular disease in adults. The task force found that statin use is beneficial for some people 40 to 75 years of age who are at increased risk for cardiovascular disease (CVD).
The USPSTF recommends that adults without a history of CVD (i.e., symptomatic coronary artery disease or ischemic stroke) use a low- or moderate-dose statin for the prevention of CVD events and mortality when all of the following criteria are met: 1) the patients are 40 to 75 years of age; 2) they have one or more CVD risk factors (e.g., dyslipidemia, diabetes, hypertension, or smoking); and 3) they have a calculated 10-year risk of a cardiovascular event of 10% or greater.
The identification of dyslipidemia and the calculation of the 10-year CVD event risk require universal lipids screening in adults 40 to 75 years of age.
Although statin use may be beneficial for the primary prevention of CVD events in some adults with a 10-year CVD event risk of less than 10%, the likelihood of benefit is smaller because of a lower probability of disease and uncertainty in individual risk prediction, according to the task force. Clinicians may choose to offer a low- or moderate-dose statin to certain adults without a history of CVD when all of the following criteria are met: 1) the patients are 40 to 75 years of age; 2) they have one or more CVD risk factors; and 3) they have a calculated 10-year risk of a cardiovascular event of 7.5% to 10.0%.
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of initiating statin use for the primary prevention of CVD events and mortality in adults 76 years of age and older without a history of heart attack or stroke.
The USPSTF makes recommendations about the effectiveness of specific preventive-care services for patients without obvious related signs or symptoms. It bases its recommendations on the evidence of both the benefits and harms of the service and on an assessment of the balance. The task force does not consider the costs of providing a service in this assessment.
The USPSTF found adequate evidence that the harms of low- to moderate-dose statin use in adults 40 to 75 years of age are small. Randomized clinical trials of statins for the primary prevention of CVD events have largely used low and moderate doses; under these conditions, statin use was not associated with serious adverse events, such as cancer, severely elevated liver enzyme levels, or severe muscle-related harms. However, the task force says, evidence concerning the association between statin use and diabetes mellitus is mixed, with one prevention trial suggesting that there may be a small increased risk of developing diabetes with the use of high-dose statins. The USPSTF found no clear evidence of reduced cognitive function associated with statin use.
Sources: USPSTF; November 13, 2016; and JAMA; November 15, 2016.