The United States Preventive Services Task Force has released new guidance for prescribing statins for patients with no history of cardiovascular disease (primary prevention), The update is based on new research available since its last guidance was published in 2016.
Moderate evidence supports prescribing statins to adults aged 40 to 75 years who have no history of CVD, have one or more CVD risk factors and a 10-year CVD risk of 10% or higher, guidance authors wrote. In patients with an otherwise identical profile but a 10-year risk between 7.5% to less than 10%, the likelihood of benefit is small, they added. In those cases, clinicians should be more selective in prescribing, they said.
Meanwhile, there is insufficient evidence to assess benefits and harms of statins for primary prevention of CVD events and death in adults aged 76 years or older, the authors added in the guidelines statement published August 23 in JAMA. The guidance does not cover use in people with active CVD (secondary prevention).
Time to curb statin enthusiasm?
The USPSTF guidance has not changed substantially since 2016, industry observers noted, and it is not as aggressive as that from the American College of Cardiology and the American Heart Association, according to a report by CNN. But some experts met its release with a call to reduce overreliance on the drugs.
A group of physician editors in JAMA Internal Medicine urged a renewed focus to “meaningfully improve CVD outcomes for all,” including investment in policies that promote healthy eating and physical exercise. Instead, the current focus on statins extols “the marginal, likely small and uncertain absolute benefits of statins for the few in primary CVD prevention,” they wrote in an editorial.
Deprescribing in seniors
The doctors urged their peers to consider deprescribing statins for primary prevention in adults aged 76 years or older and in other older adults who are unlikely to benefit from the drugs. This includes individuals at risk of polypharmacy, they added.
Questions about general overreliance on the drugs among older adults have been circulating for years, with studies finding varying evidence of benefits and risks in this demographic. In long-term care, for example, a national study published in 2020 found that more than one-third of long-stay nursing home residents aged 65 and older remain on statins, despite having life‐limiting illnesses. Some were receiving high-intensity doses.
The authors of that study called for clarified statin guidance for long-term care residents.
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