Weighing the Harms and Benefits of Using Statins for Primary Prevention: Raising the Risk Threshold
Authors: Ilana B. Richman, Joseph S. Ross
Journal: Annals of Internal Medicine (2018)

Editorials1 January 2019Weighing the Harms and Benefits of Using Statins for Primary Prevention: Raising the Risk ThresholdIlana B. Richman, MD and Joseph S. Ross, MD, MHSIlana B. Richman, MDYale University School of Medicine, New Haven, Connecticut (I.B.R., J.S.R.)Search for more papers by this author and Joseph S. Ross, MD, MHSYale University School of Medicine, New Haven, Connecticut (I.B.R., J.S.R.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-3066 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail When the American College of Cardiology (ACC) and the American Heart Association (AHA) updated their guidelines for treatment of cholesterol levels in 2013, one recommendation was particularly controversial: use of statins for primary prevention of cardiovascular disease (CVD) among adults with 10-year risk of 7.5% or higher (1). The recommendation raised important questions about the “right” risk threshold at which to start statin therapy for primary prevention, particularly because many older adults exceed this threshold on the basis of age alone. The guidelines have since made their way into clinical practice, and “7.5%” has become instantly recognizable to primary care ...References1. Stone NJ, Robinson JG, Lichtenstein AH, BaireyMerz CN, Blum CB, Eckel RH, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:2889-934. [PMID: 24239923] doi:10.1016/j.jacc.2013.11.002 CrossrefMedlineGoogle Scholar2. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol. A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Amer Coll Cardiol. November 2018. doi:10.1016/j.jacc.2018.11.003 CrossrefGoogle Scholar3. Bibbins-Domingo K, Grossman DC, Curry SJ, Davidson KW, Epling JW, García FA, et al; US Preventive Services Task Force. Statin use for the primary prevention of cardiovascular disease in adults: US Preventive Services Task Force recommendation statement. JAMA. 2016;316:1997-2007. [PMID: 27838723] doi:10.1001/jama.2016.15450 CrossrefMedlineGoogle Scholar4. 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. Ann Intern Med. 2019;170:1-10. doi:10.7326/M18-1279 LinkGoogle Scholar5. He Y, Li X, Gasevic D, Brunt E, McLachlan F, Millenson M, et al. Statins and multiple noncardiovascular outcomes: umbrella review of meta-analyses of observational studies and randomized controlled trials. Ann Intern Med. 2018;169:543-53. [PMID: 30304368]. doi:10.7326/M18-0808 LinkGoogle Scholar6. Pandya A, Sy S, Cho S, Weinstein MC, Gaziano TA. Cost-effectiveness of 10-year risk thresholds for initiation of statin therapy for primary prevention of cardiovascular disease. JAMA. 2015;314:142-50. [PMID: 26172894] doi:10.1001/jama.2015.6822 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Yale University School of Medicine, New Haven, Connecticut (I.B.R., J.S.R.)Financial Support: Dr. Richman is supported by the National Institutes of Health Clinical and Translational Science Awards KL2 Program (KL2TR001862).Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-3066.Corresponding Author: Joseph S. Ross, MD, MHS, Section of General Medicine, Department of Internal Medicine, Yale University School of Medicine, PO Box 208093, New Haven, CT 06520-8093; e-mail, joseph.[email protected]edu.Current Author Addresses: Dr. Richman: Yale University School of Medicine, 367 Cedar Street, Harkness A, Room 301a, New Haven, CT 06511.Dr. Ross: Section of General Medicine, Department of Internal Medicine, Yale University School of Medicine, PO Box 208093, New Haven, CT 06520-8093.This article was published at Annals.org on 4 December 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoFinding the Balance Between Benefits and Harms When Using Statins for Primary Prevention of Cardiovascular Disease Henock G. Yebyo , Hélène E. Aschmann , and Milo A. Puhan Metrics Cited byPhysiological and Cellular Functions of Vitamin K on Cardiovascular FunctionA Randomized Trial of Alerting to Hypocholesterolemia Results of the Low Indexes of Metabolism Intervention Trial-C (LIMIT-C)Three myths about risk thresholds for prediction modelsThe 7 Habits of Highly Effective Cost-of-Care ConversationsCaroline E. Sloan, MD and Peter A. Ubel, MDTools to Help Overcome Barriers to Cost-of-Care ConversationsC. Jessica Dine, MD, MSHP, Domitilla Masi, MS, and Cynthia D. Smith, MD 1 January 2019Volume 170, Issue 1Page: 62-63KeywordsAdverse eventsAge groupsCardiovascular diseasesComputed axial tomographyDisclosureElderlyMedical risk factorsMortalityStatinsTreatment guidelines ePublished: 4 December 2018 Issue Published: 1 January 2019 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...