Statins significantly reduce cardiovascular morbidity and mortality in patients with and without coronary heart disease. Recently, much debate has focused on use of statins for primary prevention following a class-wide safety label change by the US Food and Drug Administration amidst concerns of worsened hyperglycemia. Here, we review the evidence for statins in primary prevention and offer guidance for their appropriate use.
Two meta-analyses published since 2012 unequivocally support statins for primary prevention. Data from the Cholesterol Treatment Trialists’ Collaborators demonstrated a 9% [relative risk (RR) 0.91, 95% confidence interval (CI) 0.85–0.97] reduction in all-cause mortality and a 25% (RR 0.75, 95% CI 0.70–0.80) reduction in major vascular events per 1.0 mmol/l reduction in low-density lipoprotein cholesterol, even among low-risk patients. A 2013 Cochrane review corroborated these findings including a 14% (OR 0.86, 95% CI 0.79–0.94) reduction in all-cause mortality and a 25% (RR 0.75, 95% CI 0.70–0.81) reduction in cardiovascular disease events with statin therapy despite an 18% (RR 1.18, 95% CI 1.01–1.39) increase in incident diabetes.
Statins effectively lower atherogenic lipoproteins and result in clinically significant reductions in cardiovascular morbidity and mortality. When well tolerated, the cardiovascular benefits of statins for primary prevention generally far outweigh the reported harms.
aThe Johns Hopkins Ciccarone Center for the Prevention of Heart Disease
bThe University of Maryland School of Medicine, Maryland, USA
Correspondence to Dr Michael J. Blaha, MD, MPH, Johns Hopkins Ciccarone Center for the Prevention of Heart Disease Blalock 524C, 600 N. Wolfe Street, Baltimore, MD 21287, USA. Tel: +1 410 955 7376; fax: +1 410 614 9190; e-mail: email@example.com
All authors had access to the data and played a role in writing this manuscript.