USPSTF Indications for Statins for Primary Prevention of Cardiovascular Disease

Statins are recommended for virtually all patients who have atherosclerotic cardiovascular disease (ASCVD), but the indications for prevention of ASCVD are less clear. The US Preventive Services Task Force (USPSTF) recommendation statement on statin use for primary prevention of cardiovascular disease was recently published in the Journal of the American Medical Association.1

The USPSTF lists 4 risk factors for cardiovascular disease (CVD) — dyslipidemia, diabetes, hypertension, and smoking — and bases its estimates of the patient’s risk on the ACC/AHA guideline on assessment of cardiovascular risk.2

The USPSTF recommends prescription of a statin for persons 40-75 years old who do not have signs and symptoms of CVD but do have one or more risk factors and an estimated 10-year CVD risk of 10% or greater (a grade B recommendation).

For persons 40-75 years old who have a 7.5% to 10% risk, the USPSTF recommends selectively offering a statin, taking patient values and preferences into account (a grade C recommendation).

For primary prevention of CVD events and death in persons 76 years old or older with no history of CVD who have never taken a statin, the task force finds the current evidence insufficient to assess the balance of benefits and harms of starting a statin (a grade I recommendation).

The USPSTF’s recommendations can have substantial economic consequences. An act of Congress in 2008 gave the Secretary of Health and Human Services the authority to mandate Medicare coverage of preventive services that received an A or B recommendation from the USPSTF, and Section 2713 of the Affordable Care Act requires private insurers to cover those services.3

  1. US Preventive Services Task Force. Statin use for the primary prevention of cardiovascular disease in adults: US Preventive Services Task Force recommendation statement. JAMA 2022; 328:746.
  2. DC Goff Jr et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63:2935.
  3. DM Johns and R Bayer. The paradox of authority – transformation of the USPSTF under the Affordable Care Act. N Engl J Med 2016; 375:1710.

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Comments

  1. Michael E Makover MD says:

    My colleagues and I have just published a major review in the American Journal of Preventive Cardiology. We show strong evidence that treatment should be applied much earlier in the course of atherosclerosis, applied much more broadly and should achieve much lower LDL goals than currently recommended. Current treatment protocols leave too many people unprotected and fail to prevent up 50% or more heart attacks, much less missing reducing all the many other consequences of uncontrolled atherosclerosis.

    The article is open access at:

    https://www.sciencedirect.com/science/article/pii/S2666667722000551

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