August 23/30, 2022
Statin Use for the Primary Prevention of Cardiovascular Disease in Adults
US Preventive Services Task Force Recommendation Statement

JAMA. 2022;328(8):

Abstract
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 deaths were 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.

British Guidance

(Cardiovascular disease: risk assessment and reduction, including lipid modification) recommends atorvastatin 20 mg for the primary prevention of CVD to people who have a 10% or greater 10?year risk of developing CVD without a restriction on age.

It recommends people 85 years or older can consider atorvastatin 20 mg as statins may be of benefit in reducing the risk of non?fatal myocardial infarction,but also to be aware of factors that may make treatment inappropriate.

G Mohan