The guideline-recommended risk thresholds for initiating statins for primary prevention of cardiovascular disease may be too low, a modeling study in the Annals of Internal Medicine suggests.
Researchers performed a network meta-analysis of studies comparing four low- or moderate-dose statins with no statins in patients aged 40 to 75 with no CVD history. They balanced statins’ potential benefit of CVD event prevention with potential harms, like myopathy, hepatic or renal dysfunction, cataracts, hemorrhagic stroke, type 2 diabetes, and cancer.
Most current guidelines recommend statin initiation when a person’s 10-year CVD risk is 7.5%–10%. In this study, the benefits only began to outweigh the risks when CVD risk was 14% for men aged 40 to 49. For men 70 to 75 years, the threshold was 21%. For women, thresholds ranged from 17% to 22%.
The authors conclude: “Our results suggest that guidelines should use higher 10-year risk thresholds when recommending statins for primary prevention of CVD and should consider different recommendations based on sex, age group, and statin type.”
Of note, guidelines released last month by the American College of Cardiology and American Heart Association consider a 10-year risk score of 7.5%–19.9% to denote “intermediate risk.”
Read full article here.
Source: NEJM Journal Watch
