USPSTF Recommends Statins for Primary Prevention of CVD in Adults
US Preventive Services Task Force Recommendation Statement (USPSTF): JAMA
NETWORK: Published on August, 2022
Cardiovascular disease (CVD) is
highly prevalent and the leading cause of morbidity and mortality. Statins are
used to prevent CVD-associated morbidity and mortality because of their
positive effects on lipid profiles as well as anti-inflammatory and other
plaque-stabilization effects.
Recommendation
The USPSTF recommends that
clinicians prescribe a statin for the primary prevention of CVD for adults aged
40 to 75 years who have 1 or more CVD risk factors (ie, dyslipidemia, diabetes,
hypertension, or smoking) and an estimated 10-year CVD risk of 10% or greater. (B recommendation).
The USPSTF recommends that
clinicians selectively offer a statin for the primary prevention of CVD for
adults aged 40 to 75 years who have 1 or more of these CVD risk factors and an
estimated 10-year CVD risk of 7.5% to
less than 10%.
The likelihood of benefit is
smaller in this group than in persons with a 10-year risk of 10% or greater. (C
recommendation).
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of initiating a statin for the primary prevention of CVD events and mortality in adults 76 years or older.
Conclusions:
In adults at increased CVD risk but without prior CVD events, statin therapy for primary prevention of CVD was associated with reduced risk of all-cause mortality and CVD events. Benefits of statin therapy appear to be present across diverse demographic and clinical populations, with consistent relative benefits in groups defined by demographic and clinical characteristics.
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Importance Cardiovascular
disease (CVD) is the leading cause of morbidity and death in the US and is the
cause of more than 1 of every 4 deaths. Coronary heart disease is the single
leading cause of death and accounts for 43% of deaths attributable to CVD in
the US. In 2019, an estimated 558 000 death was caused by coronary heart
disease and 109 000 deaths were caused by ischemic stroke.
Objective To
update its 2016 recommendation, the US Preventive Services Task Force (USPSTF)
commissioned a review of the evidence on the benefits and harms of statins for
reducing CVD-related morbidity or mortality or all-cause mortality.
Population Adults
40 years or older without a history of known CVD and who do not have signs and
symptoms of CVD.
Evidence Assessment The
USPSTF concludes with moderate certainty that statin use for the prevention of
CVD events and all-cause mortality in adults aged 40 to 75 years with no
history of CVD and who have 1 or more CVD risk factors (ie, dyslipidemia,
diabetes, hypertension, or smoking) and an estimated 10-year CVD event risk of
10% or greater has at least a moderate net benefit. The USPSTF concludes with
moderate certainty that statin use for the prevention of CVD events and
all-cause mortality in adults aged 40 to 75 years with no history of CVD and
who have 1 or more of these CVD risk factors and an estimated 10-year CVD event
risk of 7.5% to less than 10% has at least a small net benefit. The USPSTF
concludes that the evidence is insufficient to determine the balance of
benefits and harms of statin use for the primary prevention of CVD events and
mortality in adults 76 years or older with no history of CVD.
Recommendation The
USPSTF recommends that clinicians prescribe a statin for the primary prevention
of CVD for adults aged 40 to 75 years who have 1 or more CVD risk factors (ie,
dyslipidemia, diabetes, hypertension, or smoking) and an estimated 10-year CVD
risk of 10% or greater. (B recommendation) The USPSTF recommends that
clinicians selectively offer a statin for the primary prevention of CVD for
adults aged 40 to 75 years who have 1 or more of these CVD risk factors and an
estimated 10-year CVD risk of 7.5% to less than 10%. The likelihood of benefit
is smaller in this group than in persons with a 10-year risk of 10% or greater.
(C recommendation) The USPSTF concludes that the current evidence is
insufficient to assess the balance of benefits and harms of initiating a statin
for the primary prevention of CVD events and mortality in adults 76 years or
older. (I statement)
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