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The US Preventive Task Force (USPTF) has issued new recommendations that greatly expand the indications for statin use beyond dyslipidemia in adults with no signs of cardiovascular disease (CVD). The independent panel of experts called for the use of low- to moderate-dose statins to prevent heart attacks, strokes, and cardiovascular-related deaths in adults ages 40 to 75 with one or more CVD risk factors (dyslipidemia, diabetes, hypertension, or smoking) and a 10-year risk of a cardiovascular event of 10% or greater.
The committee gave the recommendation a “B” grade, meaning there is “high certainty that the net benefit is moderate or moderate certainty that the net benefit is moderate to substantial.”
The new guidelines, published in the Journal of the American Medical Association, mirror those issued by the American Heart Association (AHA) and the American College of Cardiology (ACC). They reflect a shift away from a focus on lipids alone as a risk factor worthy of statin use and, instead, urge clinicians to consider a patient’s overall risk.
“People with no signs, symptoms, or history of cardiovascular disease can still be at risk for having a heart attack or stroke,” the task force’s chair, Kirsten Bibbins-Domingo, told the Washington Post.
In adults 40 to 75 with no history of CVD and 1 or more risk factors but a 10-year risk of 7.5% to 10%, the committee notes that the benefits from statins are smaller given a lower probability of disease and uncertainty in individual risk prediction. Thus, it recommended against routinely prescribing the medications.
In adults 76 and older with no history of heart attack or stroke, the committee did not find enough evidence to assess the risk/benefit balance of beginning statins to prevent CVD.
The guidelines do not apply to people with a low-density lipid cholesterol level greater than 190 mg/dL or known familial hypercholesterolemia. These individuals typically require statin use regardless of age or other risk factors.
The committee noted that the currently used risk assessment—which uses the Pooled Cohort Equations from the 2013 AHA/ACC guidelines on the assessment of cardiovascular risk—can overestimate actual risk. Thus, it advises that the risk estimation tool be used as a starting point to discuss the issue of lifelong statin therapy with patients.