The Use of Statins in Primary Prevention of Cardiovascular Disease: Benefits versus Risks

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Authors: Adji Prayitno Setiadi, Sylvi Irawati, Bobby Presley, Eko Setiawan, and Yosi Irawati Wibowo
Page Range: 129-138
Published in: World Heart Journal, 14#2 (2022)
ISSN: 1556-4002

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Table of Contents

ABSTRACT

Background: Cardiovascular disease (CVD) remains a major global health issue. The use of statins in people with a history of CVD is generally well established, however, debate remains about their use for primary prevention in people without CVD. This narrative review aims to present studies related to the benefits and risks of taking statins for primary prevention of CVD. An internet search of the Cochrane Library (2006 to 2021) and PubMed (2006 to 2021) used the following keywords: Hydroxymethylglutaryl-CoA Reductase Inhibitors, statin OR statins; cardiovascular disease, heart disease, coronary disease; primary prevention. Systematic review/ meta-analyses-based articles were included in the review. The studies reported positive outcomes of statins, particularly in relation with reduction in all-cause mortality, non-fatal MI, and non-fatal stroke. Some adverse events were also reported, such as muscle problems, diabetes, liver dysfunctions, and renal and eye disorders, However, the risks attributable to statins were considerably lower and thus did not outweigh the benefits in preventing CVD. It should be acknowledged that the decision to initiate statins for primary prevention should not solely depend on the LDL-C value, but also on overall CVD risk factors for a particular individual, as can be seen in three major guidelines from the American College of Cardiology/ American Heart Association (ACC/AHA) – 2019, Canadian Society of Cardiology (CCS) – 2021, and the European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) – 2019. The risks attributable to statins were relatively low, and thus did not outweigh the benefits in preventing CVD.

Keywords: statin, primary prevention, cardiovascular risk factor, cardiovascular disease

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