Statins may be significantly overprescribed for primary prevention, computer model suggests

An analysis compared risk of drug-related events, including myopathy, hepatic dysfunction, and incident diabetes, to predicted cardiovascular benefit for men and women at various ages.

Current guidelines may be recommending statins for patients who would experience more harm than benefit from them, according to a computer model that examined primary prevention for those with a 10-year cardiovascular disease (CVD) risk of 7.5% to 10%.

Researchers calculated the risk threshold at which the benefits of statins outweighed their harms, with separate estimates for men and women across various age groups. Disease-related events and drug-related adverse events (myopathy, hepatic dysfunction, and incident diabetes) were projected over time, using a network meta-analysis of primary prevention trials, a preference survey, and selected observational studies among people 40 to 75 years of age with no history of CVD. The primary outcome was the 10-year risk for CVD at which statins provide at least a 60% probability of net benefit. Results were published Dec. 4 by Annals of Internal Medicine.

Younger men had net benefit at a lower 10-year risk for CVD than older men (14% for ages 40 to 44 years vs. 21% for ages 70 to 75 years). In women, the 10-year CVD risk required to see net benefit was higher (17% for ages 40 to 44 years vs. 22% for ages 70 to 75 years). Atorvastatin and rosuvastatin provided net benefit at lower 10-year risks than simvastatin and pravastatin. Harms consistently exceeded benefits until 10-year CVD risk thresholds were substantially higher than recommended by current guidelines, the researchers noted.

An accompanying editorial said that the study authors included a wide range of adverse events for statin therapy that have not been considered in the development of guidelines. Regardless, the study may help to inform decision-making for older adults who are more concerned about the harms of treatment, the editorial said.

The editorial noted that initiation of statin therapy for primary prevention should be sensitive to patient preferences, including the burden of taking a pill daily, and patients may weigh risks or benefits more heavily when making a decision to take a statin.

“Indeed, primary prevention of CVD must be patient-centered, because healthy patients are asked to assume risk, benefits are experienced only as the absence of disease, and uncertainty lurks beneath every choice,” the editorialist wrote.