From the Guidelines
Statins in Primary Prevention
Statins are effective in primary prevention of cardiovascular events, with a significant reduction in major vascular events observed in individuals with elevated cardiovascular risk 1.
Key Findings
- Statin therapy is associated with a 20-30% relative risk reduction in non-fatal myocardial infarction, non-fatal stroke, and cardiovascular mortality over a 5-year treatment period 1.
- The benefits of statin therapy in primary prevention are generally observed after 1-2 years of treatment, with continued therapy resulting in sustained reductions in cardiovascular risk 1.
- Moderate-intensity statin therapy is recommended for primary prevention in individuals with an estimated 10-year ASCVD risk of 7.5% or higher 1.
- The US Preventive Services Task Force recommends offering a low- to moderate-dose statin to certain adults without a history of CVD when they have a calculated 10-year risk of a cardiovascular event of 7.5% to 10% 1.
Patient Selection
- Individuals aged 40 to 75 years with one or more CVD risk factors (e.g., dyslipidemia, diabetes, hypertension, or smoking) may benefit from statin therapy for primary prevention 1.
- The decision to initiate statin therapy should be based on a clinician-patient discussion of the potential benefits and harms, as well as consideration of patient preferences and values 1.
Statin Therapy
- Atorvastatin 10-20mg daily and rosuvastatin 5-10mg daily are examples of statin medications that have demonstrated significant reductions in major vascular events in primary prevention trials 1.
- The choice of statin and dose should be individualized based on the patient's baseline LDL-C level, ASCVD risk, and potential for adverse effects 1.
From the FDA Drug Label
To reduce the risk of major adverse cardiovascular (CV) events (CV death, nonfatal myocardial infarction, nonfatal stroke, or an arterial revascularization procedure) in adults without established coronary heart disease who are at increased risk of CV disease based on age, high-sensitivity C-reactive protein (hsCRP) ≥2 mg/L, and at least one additional CV risk factor. Rosuvastatin significantly reduced the risk of major CV events (252 events in the placebo group vs. 142 events in the rosuvastatin group) with a statistically significant (p<0. 001) relative risk reduction of 44% and absolute risk reduction of 1. 2%
Statins, such as rosuvastatin, can help in primary prevention of major adverse cardiovascular events in adults without established coronary heart disease who are at increased risk of CV disease based on age, hsCRP ≥2 mg/L, and at least one additional CV risk factor, with a significant reduction in risk 2.
- The primary end point was a composite end point consisting of the time-to-first occurrence of any of the following major CV events: CV death, nonfatal myocardial infarction, nonfatal stroke, hospitalization for unstable angina or an arterial revascularization procedure.
- Key benefits of rosuvastatin include reduction in LDL-C, hsCRP, total cholesterol, and serum triglyceride levels, as well as an increase in HDL-C 2.
From the Research
Statins in Primary Prevention
Statins, also known as HMG-CoA reductase inhibitors, have been shown to be effective in reducing cardiovascular morbidity and mortality in patients with and without coronary heart disease 3. The benefits of statins in primary prevention have been demonstrated in several studies, including a 2013 Cochrane review that found a 14% reduction in all-cause mortality and a 25% reduction in cardiovascular disease events with statin therapy 3.
Reduction in Cardiovascular Events
The use of statins in primary prevention has been associated with a significant reduction in major vascular events, including non-fatal myocardial infarction, stroke, and unstable angina 4. A meta-analysis of 17 trials found that statins reduced the risk of myocardial infarction and revascularization in elderly patients with primary prevention 5. Another study found that atorvastatin reduced the relative risk of primary coronary heart disease events by 36% compared with placebo in patients with hypertension 6.
Benefits and Harms
While statins have been shown to be effective in reducing cardiovascular events, they have also been associated with an increased risk of certain harms, including myopathy, renal dysfunction, and hepatic dysfunction 4. However, the benefits of statins in primary prevention generally outweigh the risks, particularly in high-risk individuals 7. A study found that atorvastatin and rosuvastatin were the most effective statins in reducing cardiovascular events, while atorvastatin appeared to have the best safety profile 4.
Individualized Treatment
The prescription of statins for primary prevention should be individualized based on clinical judgment, particularly for low-risk individuals 7. The use of statins in primary prevention should be balanced against the risk of "overmedicating" the general population, and the cost-effectiveness of such a strategy should be considered 7.
Key Findings
- Statins reduce cardiovascular morbidity and mortality in patients with and without coronary heart disease 3
- Statins are associated with a significant reduction in major vascular events, including non-fatal myocardial infarction, stroke, and unstable angina 4
- The benefits of statins in primary prevention generally outweigh the risks, particularly in high-risk individuals 7
- Atorvastatin and rosuvastatin are the most effective statins in reducing cardiovascular events, while atorvastatin appears to have the best safety profile 4