The US Preventive Services Task Force (USPSTF) gives a B grade recommendation for the use of low- to moderate-dose statins in adults between 40 and 75 years of age at risk for cardiovascular disease (CVD) and a C grade recommendation for the selective use of low- to moderate-dose statins in adults who are not at risk for CVD, according to the recommendation statement published in JAMA.

The USPSTF notes that there is insufficient evidence to assess the benefits and harms of initiating statin therapy in adults older than 76 years of age.

The task force reviewed evidence regarding the benefits and harms of screening and treatment for dyslipidemia in adults older than 21 years of age and the benefits and harms of statin use in reducing CVD events or mortality in adults without a history of CVD. They also examined whether the benefits vary by patient subgroup, clinical characteristics, or dosage, and examined the benefits of various treatments for adults older than 40 years of age without a history of CVD. The updated recommendation replaces the USPSTF 2008 recommendation on screening for lipid disorders in adults.


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The USPSTF found that adults without a history of CVD should use a low- to moderate-dose statin to prevent CVD events when they are between 40 and 75 years of age, have more than 1 CVD risk factor including dyslipidemia, diabetes, hypertension, or smoking, and have a calculated 10-year risk of an adverse event of 10% or greater.

The task force found that the harms of statin use in this population, such as severely elevated liver enzyme levels or severe muscle-related harms, are small. In addition, there was adequate evidence to show that low- to moderate-dose statins reduce the probability of CVD events, such as myocardial infarction or ischemic stroke, and mortality by at least a moderate amount.

While some patients may benefit from statin therapy if they have a 10-year risk of less than 10%, the USPSTF notes that this benefit will likely be smaller because of a lower probability of disease.

In response to public comment, the task force clarified its rationale for the recommendation for an evaluation of CVD risk factors in addition to the use of a risk calculator, noting that reliance on the risk calculator alone may be problematic because of the overestimation of risk in some patient populations. The task force also clarified that these recommendations do not apply to patients with very high CVD risk, as these patients should be screened in accordance with clinical judgment for the treatment of dyslipidemia.

Editorial Comments on the Guidelines

In an accompanying editorial, Rita F. Redberg, MD, MSc, and Mitchell H. Katz, MD, from the Department of Medicine at the University of California in San Francisco, note that clinicians must verify that the medication will lead to a better quality of life, longer life, or both before recommending statin therapy to a patient.

“Given the serious concerns about the harms of the reliance on statins for primary prevention, it is in the interest of public health and the medical community to refocus efforts on promoting a heart healthy diet, regular physical activity, and not smoking,” they noted.

However, Philip Greenland, MD, and Robert O. Bonow, MD, MS, from the Northwestern University Feinberg School of Medicine in Chicago, Illinois, stated in an additional editorial that every patient older than 40 years of age should be considered for statin therapy.

“All of the guidelines are correct in suggesting that additional trial evidence is needed for older adults, but this will be years in the future. Until such trial evidence is available, it is reasonable to extrapolate data from younger patients to include otherwise healthy individuals older than 75 years, and it is not necessary to stop statin therapy when a 75-year-old turns 76,” they wrote.

“Clinical judgment and patient input are critical components of the decision process, especially for older patients and those at lower risk,” they concluded.

For more information, watch the JAMA interview with author Douglas Owens, MD. 

References

  1. US Preventive Services Task Force. Statin use for the primary prevention of cardiovascular disease in adults: US Preventive Services Task Force recommendation statement. JAMA. 2016;316(19):1997-2007. doi: 10.1001/jama.2016.15450.
  2. Greenland P, Bonow RO. Interpretation and use of another statin guideline. JAMA.2016. doi: 10.1001/jamacardio.2016.4950.
  3. Redberg, RF, Katz MH. Statins for primary prevention: The debate is intense, but the data are weak. JAMA Intern Med. 2016. doi: 10.1001/jamainternmed.2016.7585.

This article originally appeared on Clinical Advisor