Mangione CM, Barry MJ, Nicholson WK, et al. Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2022 Aug 23;328(8):746-753. doi: 10.1001/jama.2022.13044.
Abstract

Importance: Cardiovascular disease (CVD) is the leading cause of morbidity and death in the US and is the cause of more than 1 of every 4 deaths. Coronary heart disease is the single leading cause of death and accounts for 43% of deaths attributable to CVD in the US. In 2019, an estimated 558?000 deaths were caused by coronary heart disease and 109?000 deaths were caused by ischemic stroke.

Objective: To update its 2016 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a review of the evidence on the benefits and harms of statins for reducing CVD-related morbidity or mortality or all-cause mortality.

Population: Adults 40 years or older without a history of known CVD and who do not have signs and symptoms of CVD.

Evidence Assessment: The USPSTF concludes with moderate certainty that statin use for the prevention of CVD events and all-cause mortality in adults aged 40 to 75 years with no history of CVD and who have 1 or more CVD risk factors (ie, dyslipidemia, diabetes, hypertension, or smoking) and an estimated 10-year CVD event risk of 10% or greater has at least a moderate net benefit. The USPSTF concludes with moderate certainty that statin use for the prevention of CVD events and all-cause mortality in adults aged 40 to 75 years with no history of CVD and who have 1 or more of these CVD risk factors and an estimated 10-year CVD event risk of 7.5% to less than 10% has at least a small net benefit. The USPSTF concludes that the evidence is insufficient to determine the balance of benefits and harms of statin use for the primary prevention of CVD events and mortality in adults 76 years or older with no history of CVD.

Recommendation: The USPSTF recommends that clinicians prescribe a statin for the primary prevention of CVD for adults aged 40 to 75 years who have 1 or more CVD risk factors (ie, dyslipidemia, diabetes, hypertension, or smoking) and an estimated 10-year CVD risk of 10% or greater. (B recommendation) The USPSTF recommends that clinicians selectively offer a statin for the primary prevention of CVD for adults aged 40 to 75 years who have 1 or more of these CVD risk factors and an estimated 10-year CVD risk of 7.5% to less than 10%. The likelihood of benefit is smaller in this group than in persons with a 10-year risk of 10% or greater. (C recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of initiating a statin for the primary prevention of CVD events and mortality in adults 76 years or older. (I statement).

Ratings by Clinicians (at least 3 per Specialty)
Specialty Score
Family Medicine (FM)/General Practice (GP)
General Internal Medicine-Primary Care(US)
Internal Medicine
Cardiology
Public Health
Comments from MORE raters

Cardiology rater

If patients choose to continue to wreck their health with poor lifestyle, then a statin may protect them a little bit. The smart thing is to stop harming the body. Doctors in general do a terrible job at making this clear to patients. This study is a typical example of where common sense has left the medical profession. This is a study of how to cleverly re-arrange the deckchairs on the Titanic without correcting the course. The end result is predictable and certain. A fundamental re-think in priorities needs to take place to save billions spent on health interventions that are futile and unintelligent. Medicine needs to lead a smart revolution. Lifestyle is the only way to reduce disease, create health, and save money better spent on other things.

Family Medicine (FM)/General Practice (GP) rater

Nothing much different than before it seems. Not an A recommendation, just a B. Much as the statement is meant to be brief, quoting relative risk reduction tends to magnify the effect versus NNT for how long, or cost to prevent one event or death. It is a hard sell as many patients who should be on statins per these recommendations refuse. They feel healthy and are averse to taking a pill every day forever.

General Internal Medicine-Primary Care(US) rater

There is nothing new here but it effects enough patients that it is worth repeating.

Internal Medicine rater

Excellent, most practical, and invaluable source for community physicians and hospitalists for shared decision-making about statin therapy for primary prevention against cardiovascular events and all-cause mortality.