Statins reduce heart attacks and strokes in people 40 to 75 years of age who are at risk of heart disease

Chou R, Dana T, Blazina I, et al. Statins for Prevention of Cardiovascular Disease in Adults: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2016;316:2008-24.

Review question

In adults 40 years of age or older who have no history of heart (cardiovascular) disease, what are the benefits and harms of statin drugs?

Background

Heart disease includes diseases of the heart or its blood vessels, such as coronary heart disease (ischemic heart disease). Some heart disease is caused by an excess of some types of fat (cholesterol) in the blood.

People who have heart disease are often prescribed statins. These drugs lower cholesterol levels in the blood and reduce the risk of future heart disease–related events such as heart attacks or strokes. Statins may also prevent these events in people who do not have heart disease but are at risk of getting it.

How the review was done

The researchers did a systematic review, searching for English-language studies up to June 2016.

They found 19 randomized controlled trials with 71,344 people (average age 51 to 66 years).

The key features of the trials were:

• people were at risk of getting heart disease, and a few (less than 10%) already had it;
• treatment was a statin, including atorvastatin, cerivastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, or simvastatin;
• statins were compared with a placebo or no statin treatment; and
• people were followed for 6 months to 6 years.

What the researchers found

Compared with placebo or no statin treatment:

• statins reduced heart attacks, strokes, any heart disease–related events, and death due to heart disease or any cause; and
• statins did not increase risk for serious adverse events (such as cancer, muscle pain, muscle breakdown or increased liver enzymes).

Conclusion

In people 40 to 75 years of age who don’t have heart disease, but are at risk of getting it, statins reduce heart attacks, strokes, heart disease–related events, and death due to heart disease or any cause.

Based on the findings of this review and other considerations, the U.S. Preventive Services Task Force made recommendations about the use of statins in people who don’t have heart disease but are at risk of getting it. You can find these recommendations in the following document: U.S. Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, et al. Statin use for the primary prevention of cardiovascular disease in adults: U.S. Preventive Services Task Force recommendation statement. JAMA. 2016;316:1997-2007. 27838723 or at U.S. Preventive Services Task Force.

A personal risk calculator recommended by the U.S. Preventive Services Task Force is available at www.cvriskcalculator.com.

Statins vs control (placebo or no statins) in adults 40 to 75 years of age without heart disease but at increased risk of getting heart disease*

*Some trials included people younger than 40 years of age or older than 75 years of age; however, the average age of people across all trials was 51 to 66 years. Some trials included a few people (< 10%) who already had heart disease.

†Including cancer, muscle pain, muscle breakdown, and increased liver enzymes.

‡Although the rates for the 2 groups look a little different, the differences were not statistically significant. This means that the differences could simply be due to chance rather than due to the different treatments.