Statin therapy for young adults: A long-term investment worth considering

HMG coenzyme A reductase inhibitors (statins) significantly decrease low-density lipoprotein-cholesterol, resulting in stabilization, and in some cases regression, of atherosclerotic plaque with subsequent reduction in atherosclerotic cardiovascular disease (ASCVD) events. To date, there remains a paucity of data to guide the use of statins in young adults (20-49 years old). We herein aim to summarize the potential benefits and risks for statin therapy in younger adults, outlining a possible approach to statin use in young adults. Early identification and treatment of young individuals at risk for ASCVD offers the potential to significantly reduce the lifetime risk of ASCVD. However, there is a paucity of data on the potential side effects of long-term statin use over many decades. Comprehensive risk assessment, including calculation of life-time ASCVD risk, as well as incorporating non-traditional risk factors including lipoprotein (a), strong family history of premature ASCVD, familial hypercholesterolemia, LDL-C level and presence of underlying systemic inflammatory disorders can be helpful in identifying young adults who stand to benefit the most from statin therapy. Selective use of coronary artery calcium (CAC) assessment, as well as potentially polygenic risk scores, can be considered in situations where there remains uncertainty regarding risk assessment. Importantly, the decision for statin treatment should occur in the context of a patient centered shared decision-making process.