USPSTF Statin Recommendations for Cardiovascular Disease Stay Consistent

Updates to the US Preventative Services Task Force (USPSTF) recommendations on statins for cardiovascular disease (CVD) event prevention are consistent with the 2016 guidelines. CVD is the leading cause of death in the United States and coronary heart disease is responsible for the most CVD-related deaths, and approximately 558,000 people died from the condition in 2019.

Stroke is also a common cause of mortality for patients with CVD. Although men have a greater risk of mortality from CVD, women have a higher mortality from cardiovascular events, such as stroke.

“This recommendation replaces the 2016 USPSTF recommendation on statin use for the primary prevention of CVD and is generally consistent with that recommendation,” the USPSTF stated in a guidance published in JAMA.

The USPSTF conducted a systematic review of existing evidence about statins and their ability to reduce CVD-related morbidity or all-cause mortality to update its 2016 recommendation. The investigators achieved this by evaluating 44 trials that highlighted the benefits, or harm, of statin use for patients aged 40 to 75 years with no known history or symptoms of CVD.

The researchers found that statins decreased the risk of all-cause mortality for patients. They also provided moderate net benefits for individuals aged 40 to 75 years with no known CVD history, have 1 or more risk factors (i.e., diabetes), and have a 10% or greater risk of experiencing a CVD-related event within 10 years.

Those who fell within this age range, who had at least 1 risk factor, and who had a risk of a CVD event under 10% may only get small benefits from statins, according to the USPSTF. However, for adults aged 76 years and older, there is insufficient evidence about the health or harm of statins for preventing CVD-related events.

The recommendations also apply to adults aged 40 years and older who have a low-density lipoprotein cholesterol (LDL) level below 190 mg/dL and are not at very high risk of CVD. Additionally, researchers found a disproportionate risk of CVD in Black patients, according to the American College of Cardiology/American Heart Association (ACC/AHA) risk estimator; however, the researchers emphasized that the tool is limited and possibly biased.

Other studies have found that Black adults are less likely to be prescribed a statin compared to a White adult. Other factors for not being prescribed a statin include no health insurance, impoverished, or being a woman.

The 2013-2014 National Health and Nutrition Examination Survey found that more than half of patients on a statin were non-Hispanic White, whereas less than half of Black patients, and other racial minority groups, were taking one. Future studies should improve CVD risk prediction in all racial, ethnic, and socioeconomic groups, according to the USPSTF. They added that future trials should examine CV events in patients 76 years of age and older.

“The USPSTF recommends that clinicians evaluate both the presence of CVD risk factors (ie, dyslipidemia, diabetes, hypertension, or smoking) as well as estimated 10-year risk of CVD in determining which persons should initiate use of statins,” the USPSTF team concluded in the study.

Reference

US Preventative Services Task Force. Statin Use for the Primary Prevention of Cardiovascular Disease in Adults. JAMA. 2022;328(8):746-753. doi:10.1001/jama.2022.13044