• USPSTF Update

    CVD Risk, Patient Age Factor Into Statin Recommendation

    September 12, 2022, 1:25 p.m. News Staff — People ages 40 to 75 at high risk for cardiovascular disease should initiate statin use to prevent a heart attack or stroke, while those in the same age range at increased risk for CVD should consult a family physician or other primary care clinician to determine whether taking a statin is appropriate, according to an updated recommendation from the U.S. Preventive Services Task Force.

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    The update, which contains three recommendations overall (graded B, C and I, respectively), also says more research is needed to determine whether people 76 or older should start taking a statin for CVD prevention.

    The AAFP is reviewing the final recommendation statement, final evidence review and evidence summary, which were released Aug. 23, to determine the Academy’s stance. The recommendation statement is generally consistent with the task force’s 2016 recommendation on the topic.

    “Statins effectively and safely prevent first heart attacks and strokes for some people,” task force member John Wong, M.D., said in a USPSTF bulletin. “Whether someone should start taking a statin depends on their age and their risk for having a first heart attack or stroke.”

    The recommendations apply to adults 40 or older with no history, sign or symptom of CVD who are not already taking statins. They do not apply to adults with known familial hypercholesterolemia or those with a low-density lipoprotein cholesterol level greater than 190 mg/dL.

    Story Highlights

    Cardiovascular disease is the leading cause of death for men, women, and people of most racial and ethnic groups in the United States. According to the CDC, almost 700,000 people died from CVD in 2020, the most recent year for which data are available.

    High Risk Versus Increased Risk

    Adults ages 40 to 75 were considered at high risk if they had any CVD risk factor and an estimated 10-year CVD risk of 10% or greater, and at increased risk if they had any CVD risk factor and an estimated 10-year CVD risk of 7.5% to less than 10%.

    The task force found that in adults at increased risk but with no history of CVD events, statin therapy significantly reduced the risk of clinical outcomes such as stroke or heart attack by 22% to 33%, while also significantly reducing the risks of all-cause mortality and composite cardiovascular outcomes.

    Statin use also was found to reduce the risk for cardiovascular mortality, although this association was not statistically significant.

    Overall, statin therapy appeared to benefit a wide range of demographic and clinical populations, and was not significantly associated with increased risk of serious adverse events or diabetes.

    Research Needed on Inequities, More

    The task force responded to comments on drafts by clarifying language on the use of coronary artery calcium scores to determine statin use and emphasizing the need for more research to improve CVD risk prediction in all racial, ethnic and socioeconomic groups.

    “Importantly, we are using this final recommendation statement to call attention to inequities in the rates of CVD and in access to and use of statins,” said task force member Katrina Donahue, M.D., M.P.H., a professor and vice chair of research in the Department of Family Medicine at the University of North Carolina School of Medicine at Chapel Hill. “It is essential that we work to better understand the causes of these inequities and reverse the negative impacts of systemic racism on cardiovascular health.”

    The task force also called for studies to close research gaps on topics including

    • the benefits and harms of initiating statin use to prevent CVD in adults 76 or older,
    • the safety and efficacy of long-term statin use in people younger than 40 and
    • whether statin therapy is associated with increased diabetes risk.

    In addition, the update includes links to several new resources, including CDC guides on cholesterol resources for health professionals and cholesterol-lowering medicine, a podcast on statin use for the primary prevention of CVD in adults and a patient page on statins for CVD prevention.