Statins: are 10-year CVD risk thresholds too low?

  • Ann Intern Med

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • 10-year cardiovascular disease (CVD) risk thresholds for initiating statin treatment are too low and should also be adjusted based on age, sex, and type of statin, say these authors.
  • Statin benefits do not emerge until higher risk thresholds than in most current guidelines.

Why this matters

  • Authors call for reconsideration of current primary prevention recommendations in the context of potential harms.
  • Editorial says  primary prevention of CVD “must be patient-centered because healthy patients are asked to assume risk.”

Key results

  • 10-year CVD risk threshold for net statin diverged in an age-by-sex interaction:
    • Men, 40-44 years: 14%.
    • Men, 70-75 years: 21%.
    • Women, 40-44 years: 17%.
    • Women, 70-75 years: 22%.
  • With risk >21%, all ages, both sexes likely to benefit.
  • Net benefit threshold varied by statin: 
    • Atorvastatin (Lipitor): 15% threshold.
    • Rosuvastatin (Crestor): 18%.
    • Pravastatin (Pravachol): 19%.
    • Simvastatin (e.g., Zocor): 21%.

Study design

  • Modeling study, based on survey data and primary prevention trials/observational studies, of benefits vs harms at 10-year CVD risk thresholds.
  • Men, women ages 40-75 years, low/moderate-dose statins or no statins, no CVD history compared.
  • Outcome: 10-year CVD risk threshold for 60% probability of net benefit.
  • Funding: Swiss Government Excellence Scholarship Office, others.

Limitations

  • No high-dose statins.
  • Swiss population.

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