- 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.”
- 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%.
- 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.
- No high-dose statins.
- Swiss population.