Statin Guidelines Spark Debate


The new USPSTF statin recommendations sparked debate last week, eliciting four editorials published the same day in the JAMA journal family. 

The first editorial emphasized the limitations of the USPSTF’s ten-year risk framework, asserting that if physicians wait to prescribe statins until a person reaches an “arbitrary threshold” for ten-year CVD risk, atherosclerosis could develop unchecked for decades. 

A second editorial spelled out where the new guidelines do or don’t overlap with the 2018 ACC/AHA statin guidelines. 

  • The panels agree that patients aged 40-75 with a high enough 10-year ASCVD risk score should receive statin therapy. 
  • But there are also some conspicuous differences, most notably USPSTF recommends a 10-year CVD risk of 10% or greater for adults 40-75, while the ACC/AHA cites a threshold of 20% or greater.
  • Unlike the USPSTF recommendations, the ACC/AHA/MS emphasizes the clinician-patient risk discussion to reach a shared decision regarding treatment. 

A third editorial posited that the USPSTF recommendations are too conservative, pointing out that statins can be effective even for individuals with very low risk. 

  • The author also underlined the guidelines’ failure to provide important risk-factor nuances such as family history, metabolic syndrome, inflammatory disorders, and more. 

A fourth editorial recommended a new approach to tackling the CVD epidemic altogether, stating that it’s time to “curb our statin enthusiasm.” 

  • The authors noted that the US spends $25B annually on statins, and those funds may yield greater benefits if reinvested into communities to encourage healthy lifestyles. They also expressed disappointment at the lack of sex-specific analyses, as the “risk-benefit profile for statins is less favorable for women than men.”

The Takeaway

Last week, the USPSTF updated its 2016 recommendations on the use of statins for the primary prevention of cardiovascular disease. Many physicians were dissatisfied with the new guidance. Some felt the guidelines were too conservative, while others suggested shifting our focus away from statins altogether. 

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