Editing Statin (section)

===Primary prevention===
For the primary prevention of cardiovascular disease, the [[United States Preventive Services Task Force]] (USPSTF) 2016 guidelines recommend statins for those who have at least one risk factor for [[coronary heart disease]], are between 40 and 75 years old, and have at least a 10% 10-year risk of heart disease, as calculated by the 2013 ACC/AHA Pooled Cohort algorithm.<ref name="AHA 2018"/><ref name=JAMA2016/><ref>{{cite web |title=ACC/AHA ASCVD Risk Calculator |url=http://www.cvriskcalculator.com/ |website=www.cvriskcalculator.com |access-date=8 March 2019 |archive-date=9 March 2019 |archive-url=https://web.archive.org/web/20190309213928/http://www.cvriskcalculator.com/ }}</ref> Risk factors for coronary heart disease included [[dyslipidemia|abnormal lipid levels in the blood]], [[diabetes mellitus]], [[high blood pressure]], and [[smoking]].<ref name=JAMA2016>{{cite journal | vauthors = Bibbins-Domingo K, Grossman DC, Curry SJ, Davidson KW, Epling JW, García FA, Gillman MW, Kemper AR, Krist AH, Kurth AE, Landefeld CS, LeFevre ML, Mangione CM, Phillips WR, Owens DK, Phipps MG, Pignone MP | title = Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: US Preventive Services Task Force Recommendation Statement | journal = JAMA | volume = 316 | issue = 19 | pages = 1997–2007 | date = November 2016 | pmid = 27838723 | doi = 10.1001/jama.2016.15450 | s2cid = 205075217 }}</ref> They recommended selective use of low-to-moderate doses statins in the same adults who have a calculated 10-year cardiovascular disease event risk of 7.5–10% or greater.<ref name=JAMA2016/> In people over the age of 70, statins decrease the risk of cardiovascular disease but only in those with a history of heavy cholesterol blockage in their arteries.<ref>{{cite journal | title = Efficacy and safety of statin therapy in older people: a meta-analysis of individual participant data from 28 randomised controlled trials | journal = Lancet | volume = 393 | issue = 10170 | pages = 407–415 | date = February 2019 | pmid = 30712900 | pmc = 6429627 | doi = 10.1016/S0140-6736(18)31942-1 | vauthors = Armitage J, Baigent C, Barnes E, Betteridge DJ, Blackwell L, Blazing M, Bowman L, Braunwald E, Byington R, Cannon C, Clearfield M, Colhoun H, Collins R, Dahlöf B, Davies K, Davis B, De Lemos J, Downs JR, Durrington P, Emberson J, Fellström B, Flather M, Ford I, Franzosi MG, Fulcher J, Fuller J, Furberg C, Gordon D, Goto S, Gotto A }}</ref>

Most evidence suggests that statins are also effective in preventing heart disease in those with [[hypercholesterolemia|high cholesterol]] but no history of heart disease. A 2013 [[Cochrane review]] found a decrease in risk of death and other poor outcomes without any evidence of harm.<ref name="Cochrane13"/> For every 138 people treated for 5 years, one fewer dies; for every 49 treated, one fewer has an episode of heart disease.<ref name=Taylor2013/> A 2011 review reached similar conclusions,<ref name="CMAJ11"/> and a 2012 review found benefits in both women and men.<ref>{{cite journal | vauthors = Kostis WJ, Cheng JQ, Dobrzynski JM, Cabrera J, Kostis JB | title = Meta-analysis of statin effects in women versus men | journal = Journal of the American College of Cardiology | volume = 59 | issue = 6 | pages = 572–582 | date = February 2012 | pmid = 22300691 | doi = 10.1016/j.jacc.2011.09.067 | doi-access = free | title-link = doi }}</ref> A 2010 review concluded that treatment without history of cardiovascular disease reduces cardiovascular events in men but not women, and provides no mortality benefit in either sex.<ref>{{cite journal | vauthors = Petretta M, Costanzo P, Perrone-Filardi P, Chiariello M | title = Impact of gender in primary prevention of coronary heart disease with statin therapy: a meta-analysis | journal = International Journal of Cardiology | volume = 138 | issue = 1 | pages = 25–31 | date = January 2010 | pmid = 18793814 | doi = 10.1016/j.ijcard.2008.08.001 }}</ref> Two other meta-analyses published that year, one of which used data obtained exclusively from women, found no mortality benefit in primary prevention.<ref>{{cite journal | vauthors = Ray KK, Seshasai SR, Erqou S, Sever P, Jukema JW, Ford I, Sattar N | title = Statins and all-cause mortality in high-risk primary prevention: a meta-analysis of 11 randomized controlled trials involving 65,229 participants | journal = Archives of Internal Medicine | volume = 170 | issue = 12 | pages = 1024–1031 | date = June 2010 | pmid = 20585067 | doi = 10.1001/archinternmed.2010.182 | doi-access = free | title-link = doi }}</ref><ref>{{cite journal | vauthors = Bukkapatnam RN, Gabler NB, Lewis WR | title = Statins for primary prevention of cardiovascular mortality in women: a systematic review and meta-analysis | journal = Preventive Cardiology | volume = 13 | issue = 2 | pages = 84–90 | year = 2010 | pmid = 20377811 | doi = 10.1111/j.1751-7141.2009.00059.x | doi-access = free | title-link = doi }}</ref>

The [[National Institute for Health and Clinical Excellence]] (NICE) recommends statin treatment for adults with an estimated 10 year risk of developing cardiovascular disease that is greater than 10%.<ref>{{cite web |url=http://www.nice.org.uk/guidance/cg181/chapter/1-recommendations |title=Cardiovascular disease: risk assessment and reduction, including lipid modification at www.nice.org.uk |date=18 July 2014 |access-date=1 May 2017 |archive-date=12 June 2018 |archive-url=https://web.archive.org/web/20180612162609/https://www.nice.org.uk/guidance/cg181/chapter/1-recommendations |url-status=live }}</ref> Guidelines by the [[American College of Cardiology]] and the [[American Heart Association]] recommend statin treatment for primary prevention of cardiovascular disease in adults with LDL cholesterol ≥ 190&nbsp;mg/dL (4.9&nbsp;mmol/L) or those with diabetes, age 40–75 with LDL-C 70–190&nbsp;mg/dL (1.8–4.9&nbsp;mmol/dL); or in those with a 10-year risk of developing heart attack or stroke of 7.5% or more. In this latter group, statin assignment was not automatic, but was recommended to occur only after a clinician-patient risk discussion with shared decision making where other risk factors and lifestyle are addressed, the potential for benefit from a statin is weighed against the potential for adverse effects or drug interactions and informed patient preference is elicited. Moreover, if a risk decision was uncertain, factors such as family history, coronary calcium score, [[Ankle-brachial pressure index|ankle-brachial index]], and an inflammation test ([[C-reactive protein|hs-CRP]] ≥ 2.0&nbsp;mg/L) were suggested to inform the risk decision. Additional factors that could be used were an LDL-C ≥ 160&nbsp;mg/dL (4.14&nbsp;mmol/L) or a very high lifetime risk.<ref>{{cite journal | vauthors = Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM, McBride P, Schwartz JS, Shero ST, Smith SC, Watson K, Wilson PW, Eddleman KM, Jarrett NM, LaBresh K, Nevo L, Wnek J, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Smith SC, Tomaselli GF | title = 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 | journal = Circulation | volume = 129 | issue = 25 Suppl 2 | pages = S1-45 | date = June 2014 | pmid = 24222016 | doi = 10.1161/01.cir.0000437738.63853.7a | author-link3 = Alice H. Lichtenstein | doi-access = free | title-link = doi }}</ref> However, critics such as Steven E. Nissen say that the AHA/ACC guidelines were not properly validated, overestimate the risk by at least 50%, and recommend statins for people who will not benefit, based on populations whose observed risk is lower than predicted by the guidelines.<ref name="Nissen2014">{{cite journal | vauthors = Nissen SE | title = Prevention guidelines: bad process, bad outcome | journal = JAMA Internal Medicine | volume = 174 | issue = 12 | pages = 1972–1973 | date = December 2014 | pmid = 25285604 | doi = 10.1001/jamainternmed.2014.3278 }}</ref> The [[European Society of Cardiology]] and the European Atherosclerosis Society recommend the use of statins for primary prevention, depending on baseline estimated cardiovascular score and LDL thresholds.<ref>{{cite journal | vauthors = Reiner Ž, Catapano AL, De Backer G, Graham I, Taskinen MR, Wiklund O, Agewall S, Alegría E, Chapman MJ, Durrington P, Erdine S, Halcox J, Hobbs RH, Kjekshus JK, Perrone Filardi P, Riccardi G, Storey RF, David W | title = [ESC/EAS Guidelines for the management of dyslipidaemias] | journal = Revista Espanola de Cardiologia | volume = 64 | issue = 12 | pages = 1168.e1–1168.e60 | date = December 2011 | pmid = 22115524 | doi = 10.1016/j.rec.2011.09.015 | hdl = 2268/205760 }}</ref>