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Statins are being overprescribed, study suggests

The risks of statins for primary prevention are greater than the benefits for many patients

Ingrid Torjesen

Tuesday, 04 December 2018

The 10-year cardiovascular risk levels for which guidelines recommend statins for primary prevention are too low, a study* published in Annals of Internal Medicine shows.

The study used a computer model to examine the benefits and harms on the use of statins for primary prevention of people in the general population aged 40 to 75 years, and found that they provided net benefits only at substantially higher 10-year risk of cardiovascular disease (CVD) thresholds than the 7.5% to 10% thresholds recommended by guidelines.

The National Institute for Health and Care Excellence recommends that stains are prescribed to patients with a 10% or greater 10-year cardiovascular risk.

The study found that the benefits of statins only start to outweigh their risks, depending on age and sex, at thresholds of between 14 and 22% risk of CVD over 10 years.

The 10-year risk for CVD at which statins provide at least a 60% probability of net benefit was lower for younger age groups and in men. In men it was 14% for those aged 40 to 44 years and 21% for those aged 70 to 75 years, and in women it was 17% for 40 to 44-years-olds and 22% for 70 to 75-year-olds.

The threshold also varied according to the statin used. For example, among men aged 45 to 49 years, net benefits were seen at a 10-year CVD risk of 15% for atorvastatin compared with 18% for rosuvastatin, 19% for pravastatin, and 21% for simvastatin.

“Our results suggest that higher 10-year risk thresholds for prescription of statins may be warranted than what current guidelines recommend,” the researchers said.

*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. 2018. DOI: 10.7326/M18-1279

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