USPSTF Issues Draft Recommendations on Statin Use for Primary Prevention of CVD in Adults

February 22, 2022—The United States Preventive Services Task Force (USPSTF) announced the posting of a draft recommendation statement on the use of statins to prevent cardiovascular disease (CVD), including heart disease and stroke.

The Task Force’s draft recommendation statement and draft evidence review have been posted for public comment on the Task Force website at www.uspreventiveservicestaskforce.org. Comments can be submitted from February 22 to March 21, 2022, at www.uspreventiveservicestaskforce.org/tfcomment.htm.

The task force announcement noted that CVD is the leading cause of death in the United States, and that, for some people, statins are an effective and safe way to prevent heart attacks and strokes.

“Statins are an important tool for preventing CVD and prolonging life,” stated Task Force member John Wong, MD, in the USPSTF press release. “Whether someone should start taking a statin to prevent a first heart attack or stroke largely depends on their age and risk for CVD.”

The recommendations only apply to people without a history of CVD and who are not already taking statins, advised the USPSTF.

As summarized in the USPSTF press release, the recommendations are:

• People aged 40 to 75 years who are at high risk for CVD should take a statin to prevent a first heart attack or stroke. This is a B grade recommendation, meaning it is recommended.
• People aged 40 to 75 years who are at increased risk, but not at high risk, for CVD may benefit from statin use and should decide with their clinician if taking a statin is right for them. This is a C grade recommendation, indicating it depends on the patient’s situation.
• For people aged ≥ 76 years, more research is needed on whether they should start taking statins. This is an I statement, meaning the balance of benefits and harms cannot be determined.

According to the USPSTF, for people aged 40 to 75 years, determining CVD risk is based on (1) an individual’s estimated chance of having a first heart attack or stroke within the next 10 years and (2) whether the person has an additional risk factor for CVD. These risk factors are high cholesterol, high blood pressure, diabetes, and smoking.

For people aged ≥ 76 years, there is not enough evidence on the benefits and harms to make a recommendation for or against starting a statin to prevent a first attack or stroke. In the absence of this evidence, clinicians should use their judgment as to whether to offer a statin to a patient in this age group.

Rates of statin use among those at risk for CVD vary by race and ethnicity, income level, insurance level, access to health care, and other factors. Statin use is the lowest among Hispanic adults. It is also low among Black adults, which is especially concerning given that Black people have the highest rates of CVD, noted the USPSTF.

Carol Mangione, MD, Vice Chair of the USPSTF, stated, “The Task Force urgently calls for more research to better understand and help eliminate the inequities in CVD and statin use among Black and Hispanic communities. We are committed to helping reverse the negative impacts of systemic racism on cardiovascular health, such as by identifying ways to improve access to medications that could reduce racial and ethnic disparities.”