Selecting Patients for Statin Therapy in Primary Prevention If We Could Only Predict the Future ∗

Statins are effective in the primary and secondary prevention of coronary heart disease and stroke. Although many would agree that primary prevention of atherosclerotic cardiovascular disease (ASCVD) is preferable to secondary prevention, no consensus exists on how to best identify individuals at risk for the disease, when to commence screening and risk assessment, at what age to start (or stop) treatment, how to treat, and how intensively to treat. The 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines concluded that net benefit was sufficient to recommend statin treatment for patients with primary low-density lipoprotein (LDL) cholesterol elevations ≥190 mg/dl and for those age 40 to 75 years with an LDL cholesterol level between 70 and 189 mg/dl and ≥7.5% 10-year ASCVD risk derived from the pooled cohort risk equation (1). The guideline authors further emphasized that risk stratification should be followed by a clinician–patient discussion and shared decision-making. Although several investigator groups have reported good calibration and case discrimination with the pooled cohort risk equation, others found overestimation of ASCVD risk.
Source: Journal of the American College of Cardiology - Category: Cardiology Source Type: research