Primary Prevention of Cardiovascular Disease with Statin Therapy

Patient Selection for Statin Therapy

The American Academy of Family Physicians recommends that adults aged 40-75 years without history of cardiovascular disease who have ≥1 cardiovascular disease risk factor and a calculated 10-year cardiovascular disease event risk of ≥10% should receive a low- to moderate-dose statin (B recommendation) 1, 2
Adults aged 40-75 years without history of cardiovascular disease who have ≥1 cardiovascular disease risk factor and a calculated 10-year cardiovascular disease event risk of 7.5-10% may selectively be offered a low- to moderate-dose statin (C recommendation) 1, 4
Evidence is insufficient to assess the balance of benefits and harms of initiating statin therapy in adults ≥76 years without history of cardiovascular disease (I statement) 2, 5

High-intensity statin therapy is recommended for patients with very high risk (≥20% 10-year risk) 2
The American Heart Association recommends high-intensity statin therapy for patients with severe hypercholesterolemia (LDL-C ≥190 mg/dL) 1, 2
Moderate-intensity statin therapy is recommended for intermediate-risk patients (7.5-20% 10-year risk) 1, 2

The American College of Cardiology recommends that LDL-C levels should be assessed 4-12 weeks after initiating therapy to evaluate response 1, 2
The magnitude of LDL-C reduction achieved determines clinical benefit 1, 2
Follow-up testing is needed to determine adherence and adequacy of effect 1, 2

Low- to moderate-dose statin use in adults aged 40-75 years has small harms 5
Statin use is not associated with serious adverse events such as cancer, severely elevated liver enzyme levels, or severe muscle-related harms at low to moderate doses 5
Evidence concerning the association between statin use and diabetes mellitus is mixed, with some suggestion of a small increased risk with high-dose statins 5