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Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: US Preventive Services Task Force
, Carol M Mangione1, Michael J Barry2
1University of California, Los Angeles.
Insights
Statins offer moderate benefits for primary cardiovascular disease (CVD) prevention in adults aged 40-75 with CVD risk factors and a 10% or greater 10-year risk. Selective offering is recommended for those with a 7.5% risk.
Area of Science:
- Preventive Medicine
- Cardiology
- Public Health
Background:
- Cardiovascular disease (CVD) is a leading cause of death in the US.
- Coronary heart disease and ischemic stroke account for a significant number of CVD deaths annually.
Purpose of the Study:
- To update recommendations on statin use for CVD prevention.
- To review evidence on the benefits and harms of statins in reducing CVD morbidity and mortality.
Main Methods:
- Systematic review of evidence on statin use for primary CVD prevention.
- Evaluation of benefits and harms in adults aged 40-75 without a history of CVD.
Main Results:
- Moderate net benefit of statin use for adults aged 40-75 with 1+ CVD risk factors and a 10-year CVD risk of 10% or greater.
- Small net benefit of statin use for adults aged 40-75 with 1+ CVD risk factors and a 10-year CVD risk of 7.5% to <10%.
- Insufficient evidence to assess statin use benefits/harms in adults 76+ years for primary CVD prevention.
Conclusions:
- Clinicians should prescribe statins for primary CVD prevention in adults aged 40-75 with a 10% or greater 10-year CVD risk.
- Clinicians should selectively offer statins to adults aged 40-75 with a 7.5% to <10% 10-year CVD risk.
- Evidence is insufficient for statin initiation in adults 76+ for primary CVD prevention.
Importance:
Cardiovascular disease (CVD) is the leading cause of morbidity and death in the US and is the cause of more than 1 of every 4 deaths. Coronary heart disease is the single leading cause of death and accounts for 43% of deaths attributable to CVD in the US. In 2019, an estimated 558 000 deaths were caused by coronary heart disease and 109 000 deaths were caused by ischemic stroke.
Objective:
To update its 2016 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a review of the evidence on the benefits and harms of statins for reducing CVD-related morbidity or mortality or all-cause mortality.
Population:
Adults 40 years or older without a history of known CVD and who do not have signs and symptoms of CVD.
Evidence Assessment:
The USPSTF concludes with moderate certainty that statin use for the prevention of CVD events and all-cause mortality in adults aged 40 to 75 years with no history of CVD and who have 1 or more CVD risk factors (ie, dyslipidemia, diabetes, hypertension, or smoking) and an estimated 10-year CVD event risk of 10% or greater has at least a moderate net benefit. The USPSTF concludes with moderate certainty that statin use for the prevention of CVD events and all-cause mortality in adults aged 40 to 75 years with no history of CVD and who have 1 or more of these CVD risk factors and an estimated 10-year CVD event risk of 7.5% to less than 10% has at least a small net benefit. The USPSTF concludes that the evidence is insufficient to determine the balance of benefits and harms of statin use for the primary prevention of CVD events and mortality in adults 76 years or older with no history of CVD.
Recommendation:
The USPSTF recommends that clinicians prescribe a statin for the primary prevention of CVD for adults aged 40 to 75 years who have 1 or more CVD risk factors (ie, dyslipidemia, diabetes, hypertension, or smoking) and an estimated 10-year CVD risk of 10% or greater. (B recommendation) The USPSTF recommends that clinicians selectively offer a statin for the primary prevention of CVD for adults aged 40 to 75 years who have 1 or more of these CVD risk factors and an estimated 10-year CVD risk of 7.5% to less than 10%. The likelihood of benefit is smaller in this group than in persons with a 10-year risk of 10% or greater. (C recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of initiating a statin for the primary prevention of CVD events and mortality in adults 76 years or older. (I statement).
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