• CARDIAC PROCEDURES AND THERAPY

Statins are beneficial in patients with known cardiovascular disease (CVD) but less well established for primary prevention in asymptomatic patients.1 At least five authoritative guidelines, including the recent publication from the US Preventive Services Task Force, cover this issue.2–7 Their differing recommendations, however, suggest considerable uncertainty in the underlying data, causing confusion for both clinicians and patients.

The guidelines share several common themes. The essential elements for primary prevention include a healthy lifestyle, treatment of modifiable risk factors, and measurement of serum lipid concentrations in patients aged over 40 years. They agree that statins are appropriate in patients with a high risk of cardiovascular disease—for example, people over 40 with diabetes. All guidelines also recommend statins in other patients with increased cardiovascular risk but with considerable divergence in the details.

The US task force guideline recommends initiating low-to-moderate dose statins in adults aged 40 to 75 years without a history of cardiovascular disease who have at least one risk factor (dyslipidaemia, diabetes, hypertension, or smoking) and a calculated 10 year cardiovascular event risk ≥10%.2 It also …