A new modelling study involving persons aged 40 to 75 years with no history of cardiovascular disease (CVD) suggests that 10-year risk thresholds used in current guidelines to prescribe statins for primary prevention of CVD are probably substantially too low.
A new study published online Dec 3, 2018 in the Annals of Internal Medicine has suggested that instead of 7.5% to 10% 10-year risks one should use 14% risk thresholds where the benefits of statins exceed the harms.
Using an approach originally developed by the National Cancer Institute to look at tamoxifen for breast cancer prevention, the investigators show that statins provide net benefits at higher 10-year risks for CVD than are reflected in most current guidelines; 14% for men aged 40 to 44 years. The risk threshold, however, increased to 21% for aged 70 to 75. For women, the risk thresholds were higher at 17% and 22%, respectively. Individuals, who were at high risk for CVD (>21%) were likely to benefit from statins, regardless of sex or age.
Among the four commonly used statins, atorvastatin was found to have the most favorable benefit–harm balance, followed by rosuvastatin, especially for younger adults with low or medium CVD risk.
New research and/or guidelines are suggestions and recommendations, which are definitely evidence-based. While they do standardize treatment for any given condition, they are not without their limitations. They cannot be generalized as each patient is different and hence treatment has to be individualized.
Also, western data cannot be extrapolated to our Indian settings.
Do not follow guidelines blindly and give statins to every case with 10-year risk of heart disease of more than 10%.
Instead every case should be individualized based on age and other factors.
The individual risk for CVD events should be calculated before prescribing statins. This will result in individual patient harm reduction in CVD risk.
Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA