[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 34.238.190.122. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
1.
Goff  DC  Jr, Lloyd-Jones  DM, Bennett  G,  et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines.  2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.  Circulation. 2014;129(25)(suppl 2):S49-S73.PubMedGoogle ScholarCrossref
2.
Rana  JS, Tabada  GH, Solomon  MD,  et al.  Accuracy of the atherosclerotic cardiovascular risk equation in a large contemporary, multiethnic population.  J Am Coll Cardiol. 2016;67(18):2118-2130.PubMedGoogle ScholarCrossref
3.
Cook  NR, Ridker  PM.  Further insight into the cardiovascular risk calculator: the roles of statins, revascularizations, and underascertainment in the Women’s Health Study.  JAMA Intern Med. 2014;174(12):1964-1971.PubMedGoogle ScholarCrossref
4.
DeFilippis  AP, Young  R, Carrubba  CJ,  et al.  An analysis of calibration and discrimination among multiple cardiovascular risk scores in a modern multiethnic cohort.  Ann Intern Med. 2015;162(4):266-275.PubMedGoogle ScholarCrossref
5.
Mensah  GA, Brown  DW.  An overview of cardiovascular disease burden in the United States.  Health Aff (Millwood). 2007;26(1):38-48.PubMedGoogle ScholarCrossref
6.
Chou  R, Dana  T, Blazina  I,  et al.  Statin Use for the Prevention of Cardiovascular Disease in Adults: A Systematic Review for the US Preventive Services Task Force: Evidence Synthesis No. 139. Rockville, MD: Agency for Healthcare Research and Quality; 2016. AHRQ publication 14-05206-EF-2.
7.
Richardson  K, Schoen  M, French  B,  et al.  Statins and cognitive function: a systematic review.  Ann Intern Med. 2013;159(10):688-697.PubMedGoogle ScholarCrossref
8.
Yusuf  S, Bosch  J, Dagenais  G,  et al; HOPE-3 Investigators.  Cholesterol lowering in intermediate-risk persons without cardiovascular disease.  N Engl J Med. 2016;374(21):2021-2031.PubMedGoogle ScholarCrossref
9.
Chou  R, Dana  T, Blazina  I, Daeges  M, Jeanne  T.  Statins for prevention of cardiovascular disease in adults: a systematic review and meta-analysis for the US Preventive Services Task Force.  JAMA. doi:10.1001/jama.2015.15629Google Scholar
10.
Ridker  PM, Danielson  E, Fonseca  FA,  et al; JUPITER Study Group.  Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein.  N Engl J Med. 2008;359(21):2195-2207.PubMedGoogle ScholarCrossref
11.
Buckley  DI, Fu  R, Freeman  M, Rogers  K, Helfand  M.  C-reactive protein as a risk factor for coronary heart disease: a systematic review and meta-analyses for the U.S. Preventive Services Task Force.  Ann Intern Med. 2009;151(7):483-495.PubMedGoogle ScholarCrossref
12.
U.S. Preventive Services Task Force.  Using nontraditional risk factors in coronary heart disease risk assessment: U.S. Preventive Services Task Force recommendation statement.  Ann Intern Med. 2009;151(7):474-482.PubMedGoogle ScholarCrossref
13.
American Heart Association, American College of Cardiology. Pooled Cohort Equations Cardiovascular Risk Calculator. 2014. http://tools.acc.org/ASCVD-Risk-Estimator/. Accessed September 16, 2016.
14.
Ridker  PM, Cook  NR.  Statins: new American guidelines for prevention of cardiovascular disease.  Lancet. 2013;382(9907):1762-1765.PubMedGoogle ScholarCrossref
15.
Helfand  M, Buckley  DI, Freeman  M,  et al.  Emerging risk factors for coronary heart disease: a summary of systematic reviews conducted for the U.S. Preventive Services Task Force.  Ann Intern Med. 2009;151(7):496-507.PubMedGoogle ScholarCrossref
16.
Dehmer  SP, Maciosek  MV, Flottemesch  TJ.  Aspirin Use to Prevent Cardiovascular Disease and Cancer: A Decision Analysis. Rockville, MD: Agency for Healthcare Research and Quality; 2015. AHRQ publication 15-05229-EF-1.
17.
Siu  AL; U.S. Preventive Services Task Force.  Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement.  Ann Intern Med. 2015;163(10):778-786.PubMedGoogle ScholarCrossref
18.
Siu  AL; US Preventive Services Task Force.  Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women: U.S. Preventive Services Task Force recommendation statement.  Ann Intern Med. 2015;163(8):622-634.PubMedGoogle ScholarCrossref
19.
Chou  R, Dana  T, Blazina  I, Daeges  M, Bougatsos  C, Jeanne  T.  Screening for Dyslipidemia in Younger Adults: A Systematic Review to Update the 2008 US Preventive Services Task Force Recommendation: Evidence Synthesis No. 138. Rockville, MD: Agency for Healthcare Research and Quality; 2016. AHRQ publication 14-05206-EF-1.
20.
Chou  R, Dana  T, Blazina  I, Daeges  M, Bougatsos  C, Jeanne  TL.  Screening for dyslipidemia in younger adults: a systematic review for the US Preventive Services Task Force.  Ann Intern Med. 2016;165(8):560-564. PubMedGoogle ScholarCrossref
21.
Bibbins-Domingo  K, Grossman  DC, Curry  SJ,  et al; US Preventive Services Task Force.  Screening for lipid disorders in children and adolescents: US Preventive Services Task Force recommendation statement.  JAMA. 2016;316(6):625-633.PubMedGoogle ScholarCrossref
22.
Versmissen  J, Oosterveer  DM, Yazdanpanah  M,  et al.  Efficacy of statins in familial hypercholesterolaemia: a long term cohort study.  BMJ. 2008;337:a2423.PubMedGoogle ScholarCrossref
23.
Downs  JR, Clearfield  M, Weis  S,  et al.  Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS.  JAMA. 1998;279(20):1615-1622.PubMedGoogle ScholarCrossref
24.
Stone  NJ, Robinson  JG, Lichtenstein  AH,  et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines.  2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.  Circulation. 2014;129(25)(suppl 2):S1-S45.PubMedGoogle ScholarCrossref
25.
Mihaylova  B, Emberson  J, Blackwell  L,  et al; Cholesterol Treatment Trialists’ (CTT) Collaborators.  The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials.  Lancet. 2012;380(9841):581-590.PubMedGoogle ScholarCrossref
26.
Ridker  PM, Pradhan  A, MacFadyen  JG, Libby  P, Glynn  RJ.  Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: an analysis from the JUPITER trial.  Lancet. 2012;380(9841):565-571.PubMedGoogle ScholarCrossref
27.
Schatz  IJ, Masaki  K, Yano  K, Chen  R, Rodriguez  BL, Curb  JD.  Cholesterol and all-cause mortality in elderly people from the Honolulu Heart Program: a cohort study.  Lancet. 2001;358(9279):351-355.PubMedGoogle ScholarCrossref
28.
Weverling-Rijnsburger  AW, Blauw  GJ, Lagaay  AM, Knook  DL, Meinders  AE, Westendorp  RG.  Total cholesterol and risk of mortality in the oldest old.  Lancet. 1997;350(9085):1119-1123.PubMedGoogle ScholarCrossref
29.
Gu  Q, Paulose-Ram  R, Burt  VL, Kit  BK.  Prescription cholesterol-lowering medication use in adults aged 40 and over: United States, 2003-2012.  NCHS Data Brief. 2014;(177):1-8.PubMedGoogle Scholar
30.
Johansen  ME, Green  LA.  Statin use in very elderly individuals, 1999-2012.  JAMA Intern Med. 2015;175(10):1715-1716.PubMedGoogle ScholarCrossref
31.
AMDA—The Society for Post-Acute and Long-Term Care Medicine. Ten things physicians and patients should question. http://www.choosingwisely.org/societies/amda-the-society-for-post-acute-and-long-term-care-medicine/. 2015. Accessed September 16, 2016.
32.
Bibbins-Domingo  K; U.S. Preventive Services Task Force.  Aspirin Use for the Primary Prevention of Cardiovascular Disease and Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement.  Ann Intern Med. 2016;164(12):836-845.PubMedGoogle ScholarCrossref
33.
Moyer  VA; U.S. Preventive Services Task Force.  Screening for coronary heart disease with electrocardiography: U.S. Preventive Services Task Force recommendation statement.  Ann Intern Med. 2012;157(7):512-518.PubMedGoogle Scholar
34.
Siu  AL; U S Preventive Services Task Force.  Screening for abnormal blood glucose and type 2 diabetes mellitus: U.S. Preventive Services Task Force recommendation statement.  Ann Intern Med. 2015;163(11):861-868.PubMedGoogle ScholarCrossref
35.
Moyer  VA; U.S. Preventive Services Task Force.  Behavioral counseling interventions to promote a healthful diet and physical activity for cardiovascular disease prevention in adults: U.S. Preventive Services Task Force recommendation statement.  Ann Intern Med. 2012;157(5):367-371.PubMedGoogle Scholar
36.
Moyer  VA; U.S. Preventive Services Task Force.  Screening for and management of obesity in adults: U.S. Preventive Services Task Force recommendation statement.  Ann Intern Med. 2012;157(5):373-378.PubMedGoogle Scholar
37.
Hoyert  DL, Xu  J.  Deaths: preliminary data for 2011.  Natl Vital Stat Rep. 2012;61(6):1-51.PubMedGoogle Scholar
38.
Miniño  AM.  Death in the United States, 2011.  NCHS Data Brief. 2013;(115):1-8.PubMedGoogle Scholar
39.
Centers for Disease Control and Prevention (CDC).  Prevalence of coronary heart disease—United States, 2006-2010.  MMWR Morb Mortal Wkly Rep. 2011;60(40):1377-1381.PubMedGoogle Scholar
40.
Sever  PS, Dahlöf  B, Poulter  NR,  et al; ASCOT Investigators.  Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial.  Lancet. 2003;361(9364):1149-1158.PubMedGoogle ScholarCrossref
41.
Jick  SS, Bradbury  BD.  Statins and newly diagnosed diabetes.  Br J Clin Pharmacol. 2004;58(3):303-309.PubMedGoogle ScholarCrossref
42.
Culver  AL, Ockene  IS, Balasubramanian  R,  et al.  Statin use and risk of diabetes mellitus in postmenopausal women in the Women’s Health Initiative.  Arch Intern Med. 2012;172(2):144-152.PubMedGoogle ScholarCrossref
43.
Lopez-Jimenez  F, Simha  V, Thomas  RJ,  et al.  A summary and critical assessment of the 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular disease risk in adults: filling the gaps.  Mayo Clin Proc. 2014;89(9):1257-1278.PubMedGoogle ScholarCrossref
44.
Anderson  TJ, Grégoire  J, Hegele  RA,  et al.  2012 update of the Canadian Cardiovascular Society guidelines for the diagnosis and treatment of dyslipidemia for the prevention of cardiovascular disease in the adult.  Can J Cardiol. 2013;29(2):151-167.PubMedGoogle ScholarCrossref
45.
National Institute for Health and Care Excellence. Cardiovascular disease: risk assessment and reduction, including lipid modification. https://www.nice.org.uk/Guidance/CG181. 2016. Accessed September 16, 2016.
US Preventive Services Task Force
Recommendation Statement
November 15, 2016

Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: US Preventive Services Task Force Recommendation Statement

US Preventive Services Task Force
JAMA. 2016;316(19):1997-2007. doi:10.1001/jama.2016.15450
Abstract

Importance  Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the United States, accounting for 1 of every 3 deaths among adults.

Objective  To update the 2008 US Preventive Services Task Force (USPSTF) recommendation on screening for lipid disorders in adults.

Evidence Review  The USPSTF reviewed the evidence on the benefits and harms of screening for and treatment of dyslipidemia in adults 21 years and older; the benefits and harms of statin use in reducing CVD events and mortality in adults without a history of CVD events; whether the benefits of statin use vary by subgroup, clinical characteristics, or dosage; and the benefits of various treatment strategies in adults 40 years and older without a history of CVD events.

Conclusions and Recommendations  The USPSTF recommends initiating use of low- to moderate-dose statins in adults aged 40 to 75 years without a history of CVD who have 1 or more CVD risk factors (dyslipidemia, diabetes, hypertension, or smoking) and a calculated 10-year CVD event risk of 10% or greater (B recommendation). The USPSTF recommends that clinicians selectively offer low- to moderate-dose statins to adults aged 40 to 75 years without a history of CVD who have 1 or more CVD risk factors and a calculated 10-year CVD event risk of 7.5% to 10% (C recommendation). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of initiating statin use in adults 76 years and older (I statement).

×