The use of statins (drugs which lower blood cholesterol) for the primary prevention of CV disease has been controversial since the drugs became available almost 30 years ago. Primary prevention is the prevention of a disease which the patient does not have, eg a stroke or a heart attack. Secondary prevention is the prevention of a recurrence of a disease which has already afflicted the patient, like a second stroke or heart attack. There’s no controversy here.
The JAMA has just published Statin Use for the Primary Prevention of Cardiovascular Disease in Adults US Preventive Services Task Force Recommendation Statement. The group’s recommendation is: [To initiate the] use of low- to moderate-dose statins in adults aged 40 to 75 years without a history of CVD who have 1 or more CVD risk factors (dyslipidemia, diabetes, hypertension, or smoking) and a calculated 10-year CVD event risk of 10% or greater (B recommendation). The USPSTF recommends that clinicians selectively offer low- to moderate-dose statins to adults aged 40 to 75 years without a history of CVD who have 1 or more CVD risk factors and a calculated 10-year CVD event risk of 7.5% to 10% (C recommendation). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of initiating statin use in adults 76 years and older (I statement). The full report is here: Statin use for the primary prevention of cardiovascular disease in adults.
I find the recommendation for such use unconvincing. Some of the editors of the JAMA must have shared my opinion as they published an editorial by Rita Redberg, MD,MSc and Mitchell Katz, MD arguing against the use of statins for primary prevention. The editorial is here: Statins for primary prevention. One of the reasons for casting as jaundiced eye on the new advisory is: “The task force evidence report estimated that to prevent one death from any cause over a 5-year period, 244 patients would need to take a statin daily.” Quotation from the above editorial. There are other objections which you can read for yourself.
The global market for statin treatment is about $20 billion. This government recommendation is not likely to reduce this staggering sum. This is a case of where you’d be better off to take a walk than a pill.