Analysis

Should people at low risk of cardiovascular disease take a statin?

BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f6123 (Published 22 October 2013) Cite this as: BMJ 2013;347:f6123
  1. John D Abramson, lecturer 1,
  2. Harriet G Rosenberg, professor emeritus2,
  3. Nicholas Jewell, professor3,
  4. James M Wright, co-managing director and chair4
  1. 1Department of Health Care Policy, Harvard Medical School, 39 Spring Street, Ipswich, MA 01938, USA
  2. 2 Department of Social Science, York University, Toronto, Ontario, Canada
  3. 3Division of Biostatistics, School of Public Health Department of Statistics, University of California, Berkeley, CA, USA
  4. 4Therapeutics Initiative, Departments of Anesthesiology, Pharmacology and Therapeutics and Medicine, University of British Columbia, Vancouver, BC, Canada
  1. Correspondence to: J D Abramson john_abramson{at}hms.harvard.edu

A review of statins for primary prevention of cardiovascular disease could alter guidance for those with a 10 year risk of less than 10%. John Abramson and colleagues argue that statins have no overall health benefit in this population and that prescribing guidelines should not be broadened

The 2013 Cochrane review of primary prevention with statins concluded that they reduce all cause mortality and cardiovascular events without increasing the risk of adverse events among people at low risk of cardiovascular disease (<10% over 10 years).1 However, just two years earlier, a Cochrane review had concluded that existing evidence did not support the use of cholesterol lowering statins for people with <20% 10 year cardiovascular risk: “Only limited evidence showed that primary prevention with statins may be cost effective and improve patient quality of life. Caution should be taken in prescribing statins for primary prevention among people at low cardiovascular risk.”2 This conclusion was consistent with the 2006-08 guidance from the National Institute for Health and Care Excellence (NICE)3 and the 2011 update of the American Heart Association’s guidelines for the prevention of cardiovascular disease in women, both of which recommended statin therapy only when the 10 year risk of disease is 20% or greater.4

If risk is estimated using the QRISK2 score,5 by the 2011 standards just 2% of women in their 50s and 16% in their 60s qualify for statin therapy (≥ 20% 10 year risk of cardiovascular disease). For men, 9% in their 50s and 48% in their 60s qualify.6 Under the proposed 2013 standards, however, no level of risk would preclude statin therapy, raising the question whether all people over the age of 50 should be treated.1 7 We argue that the evidence does not show that the benefits of …

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