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USPSTF 2022: updated review of statins for the primary prevention of cardiovascular disease
Clinical Question
What are the benefits and harms of statin treatment for dyslipidemia in adults 21 years and older?
Bottom line
The USPSTF 2022 did not significantly change its statin recommendations for the primary prevention of CVD, including a B recommendation for adults aged 40 to 75 years with 1 or more CVD risk factors and an estimated 10-year CVD risk of 10% or greater. Clinicians should engage in shared decision-making with adults aged 40 to 75 years with an estimated 10-year CVD risk of 7.5% to less than 10% (C recommendation). Evidence remains insufficient to recommend for or against statin therapy for the primary prevention of CVD in adults aged 76 years or older. (I statement). The task force found no evidence supporting a benefit to titrating statin dose according to LDL levels, and instead recommends the use of a moderate-intensity dose for primary prevention in most persons with no further need to reassess lipid levels. 1a
Reference
Study design: Practice guideline
Funding: Government
Setting: Outpatient (any)
Synopsis
The US Preventive Services Task Force (USPSTF) found adequate evidence of a benefit of low- to moderate-dose statins for reducing the probability of cardiovascular disease (CVD) events and mortality in adults aged 40 to 75 years with at least 1 CVD risk factor and a calculated 10-year CVD event risk of 10% or greater. In addition, the harms of low- to moderate-dose statins in adults aged 40 to 75 years are small. The task force recognizes that the likelihood of benefit is smaller for adults aged 40 to 75 with an estimated 10-year risk of 7.5% to less than 10% and thus recommends individual shared decision-making. Data of benefit versus harm for persons older than 75 years remains sparse. The USPSTF recognizes that the best currently available risk-estimation tool in the United States uses the Pooled Cohort Equations calculator from the American College of Cardiology/American Heart Association (ACC/AHA) guidelines (updated 2018). The current recommendations do not apply to adults with a low-density lipoprotein (LDL) cholesterol level greater than 190 mg/dL (4.9 mmol/L). The ACC/AHA recommends statin use for primary prevention in adults aged 40 to 75 years with an estimated 10-year CVD event risk greater than or equal to 7.5%.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Comments
Shared decision making
Strange that the USPSTF recommends shared decision making for the decision to initiate a statin in a person whose CVD risk is 9% - while for another person whose CVD risk is 11% they do not.
USPSTF 2022: updated review of statins for the primary preve
Given the small benefit, would a cost analysis be worthwhile commenting on?
no
very informative
Depression screening
Seems good idea