Statin prescription in men and women at cardiovascular risk: to whom and when?

Abstract

To review the recent evidence of the effectiveness of statin therapy in the primary prevention of cardiovascular disease in men and women without established cardiovascular disease (CVD). The use of statins in patients without established CVD has important public health implications. Until recently, research has provided ambiguous answers and the reliability of treatment in older people (>65 years), women, and patients with diabetes has remained uncertain, mainly because of a lack of data or inconsistent findings within these clinically defined groups. The Justification for the use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) demonstrated a significant benefit of rosuvastatin in low-risk patients with no apparent vascular disease, low-density lipoprotein levels of less than 3.4 mmol/l, and elevated high sensitivity C-reactive protein. The latest meta-analysis of statins in 70 000 patients without established CVD confirmed the overall benefit of statins in these low-risk patients and found no significant heterogeneity of the treatment effect in the clinically defined subgroups of elderly (>65 years), women, and patients with diabetes. The use of statins in low-risk patients without CVD remains a matter of intense debate, even following the latest findings from the JUPITER. Statins reduce cardiovascular risk and mortality in this patient category. However, the overall absolute risk reductions and cost-effectiveness of long-term statin prescription should be kept in mind before prescribing statins to relatively healthy individuals. The exact threshold of baseline risk of CVD has not been determined yet and is a challenge for emerging treatment guidelines in primary prevention.