Title: Recommendation Statement on Statin Use for the Primary Prevention of Cardiovascular Disease in Adults
Year released: 2016
Society: United States Preventive Services Task Force
The USPSTF recommends the use of low- to moderate-dose statins for primary prevention of CVD in adults aged 40 to 75 years without a history of CVD who have one or more risk factors (dyslipidemia, diabetes, hypertension or smoking) and a calculated 10-year CVD event risk of 10% or greater.
Additionally, the task force recommends selectively offering statin therapy for primary prevention in adults aged 40 to 75 years with no history of CVD, with one or more risk factors and a calculated 10-year CVD event risk of 7.5% to 10%.
In these populations, the USPSTF found that statin therapy reduced the risk of all-cause and CVD-related mortality.
Universal lipid screening for adults aged 40 to 75 years is necessary for identification of dyslipidemia (LDL cholesterol >130 mg/dL or HDL cholesterol <40 mg/dL) and calculation of 10-year CVD event risk. However, the task force recommends neither for nor against dyslipidemia screening for adults aged 21 to 39 years, as there is insufficient evidence that screenings prevent adverse outcomes in the short- or long-term.
The USPSTF could not conclude whether statin therapy would reduce CV events or mortality and confer benefits in adults aged 75 years or older without history of CVD, due to insufficient evidence in this population.
The task force highlights other evidence-based recommendations for this population, including:
- aspirin use;
- screening for coronary heart disease, high blood pressure, abnormal blood glucose and type 2 diabetes;
- interventions for smoking cessation;
- counseling to promote healthy diet and exercise; and
- screening for and management of obesity.
Limitations and considerations
The task force noted the current standard CVD risk assessment tool is imperfect and has been shown to overestimate risk in validation study.
Studies have not shown a harmful effect of statins in moderate to low doses; however, one study found there may be a small increase of diabetes with the use of high-dose statins.
Additionally, these recommendations do not pertain to individuals with very high cholesterol (LDL >190 mg/dL).
Bibbins-Domingo K, et al. JAMA. 2016;doi:10.1001/jama.2016.15450.
Cardiology Today coverage: https://www.healio.com/internal-medicine/preventive-medicine/news/online/%7b1d043ada-18c3-49c5-8707-320f08886023%7d/uspstf-recommends-use-of-statins-to-prevent-cardiovascular-disease