Benefits and limitations of statin use in primary cardiovascular prevention: recent advances

Area of Science:

• Cardiology
• Preventive Medicine
• Pharmacology

Background:

• Low-density lipoprotein (LDL) cholesterol is a primary driver of atherosclerotic vascular disease (ASCVD).
• Statins, which increase LDL receptor expression, are the cornerstone of lipid-lowering therapy.
• Current statin guidelines differentiate between secondary and primary prevention strategies.

Purpose of the Study:

• To review recent advances in statin use for primary prevention in younger and older healthy individuals.
• To discuss the benefits and potential risks associated with statin therapy in primary prevention.
• To evaluate the overall benefit of statins for individuals in affluent societies based on current evidence.

Main Methods:

• Narrative review of recent scientific literature on statin therapy.
• Analysis of risk assessment tools, including 10-year and lifetime risk calculations.
• Consideration of ongoing randomized controlled trials (STAREE and PREVENTABLE) for older populations.

Main Results:

• Statins are established in secondary ASCVD prevention and for intermediate-to-high risk primary prevention.
• Biomarkers like coronary artery calcium aid risk assessment in borderline and intermediate risk groups.
• Lifetime risk calculation offers value for younger individuals' risk stratification.

Conclusions:

• Statins are generally safe and effective, particularly in secondary prevention.
• Further evidence from trials like STAREE and PREVENTABLE is needed for definitive guidance in older adults.
• The broad benefit of statins for the general population in affluent societies warrants continued evaluation.