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

PURPOSE OF REVIEW: To review the recent evidence of the effectiviness of statin therapy in the primary prevention of cardiovascular disease in men and women without established cardiovascular disease (CVD). RECENT FINDINGS: 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. SUMMARY: 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.

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