Guideline-Recommended Statin Treatment Thresholds: Are They Too Low?

Guideline-recommended thresholds for statin initiation may be too low, according to the results of a recent study.

Although many guidelines use expected risk for cardiovascular disease (CVD) over 10 years as the basis for recommending statin treatment, how the harms of treatment were weighed against benefits is often unclear, according to the study authors.

In order to “identify the expected risk above which statins provide net benefit,” they conducted a quantitative benefit-harm balance modeling study involving individuals aged 40 to 75 years with no history of CVD from a meta-analysis of primary prevention trials, a preference survey, and selected observational studies.

Overall, they found that younger men had a net benefit at lower 10-year risk for CVD than older men (14% for ages 40 to 44 years vs. 21% for ages 70 to 75 years), while the risk required for net benefit was higher in women (17% for ages 40 to 44 years vs. 22% for ages 70 to 75 years). They noted that atorvastatin and rosuvastatin provided a net benefit at lower 10-year risks than simvastatin and pravastatin.

“Statins provide net benefits at higher 10-year risks for CVD than are reflected in most current guidelines. In addition, the level of risk at which net benefit occurs varies considerably by age, sex, and statin type.”

—Michael Potts

Reference:

Yebyo HG, Aschmann HE, Puhan MA. Finding the balance between benefits and harms when using statins for primary prevention of cardiovascular disease: A modeling study [published online December 4, 2018. Ann Intern Med. doi: 10.7326/M18-1279.