Should Guidelines Use Higher Risk Thresholds When Recommending Statins for Primary CVD Prevention?

A higher 10-year risk threshold than what the current guidelines recommend may be warranted when considering statin therapy for primary cardiovascular disease (CVD) prevention, according to a study published in Annals of Internal Medicine. These results suggest that guidelines should incorporate using higher 10-year risk thresholds when recommending statins for the purpose of primary CVD prevention, taking into account sex, age, and statin type.

Current CVD risk thresholds used as the basis for decisions regarding the prescription of statins emphasize the benefits of statin therapy, with potential harm outcomes having little effect.

Researchers in this quantitative benefit-harm balance modeling study evaluated benefits vs harms for using low- to moderate-dose statins for primary CVD prevention in individuals age 40 to 75 without a history of CVD events over a time horizon of 10 years. Individuals older than 75 were excluded due to scarce data.

Data were obtained through selected observational studies, a preference survey, and a primary prevention trials network meta-analysis. Outcome measures included the 10-year CVD risk at which there is at least a 60% probability of net benefit from statins, taking into account baseline risk, competing risk for noncardiovascular death, and preferences for and frequencies of statin harms and benefits.

Younger men were shown to have a net benefit at a lower 10-year CVD risk compared with older men (14% for 40-44 years vs 21% for 70-75 years). The risk for a net benefit was higher for women (17% for 40-44 years vs 22% for 70-75 years).

However, regardless of age or sex, patients at a high risk for CVD (>21%) are likely to benefit from statin therapy. As for individual statins, rosuvastatin and atorvastatin provided net benefit at lower 10-year CVD risks than pravastatin and simvastatin.

Study investigators concluded that updating “recommendations would substantially improve selection of persons eligible for statin therapy for primary prevention of CVD.”

Reference

Yebyo HG, Aschmann HE, Puhan MA. Finding the balance between benefits and harms when using statins for primary prevention of cardiovascular disease: a modeling study [published online December 4, 2018]. Ann Intern Med. doi: 10.7326/M18-1279