title: Statins in the primary prevention of cardiovascular disease.
abstract: Statins are widely used in the evidence-based lowering of cardiovascular disease (CVD) risk. The use of these drugs for secondary prevention of CVD is well founded, but their expanding use in primary prevention--in individuals without documented CVD--has raised some concerns. Firstly, evidence suggests that, in primary prevention, statins substantially decrease CVD morbidity, but only moderately reduce CVD mortality. Secondly, long-term statin use might cause adverse effects, such as incident diabetes mellitus. Thirdly, the cost-effectiveness of such a strategy is unclear, and has to be balanced against the risk of 'overmedicating' the general population. Data clearly support the use of statins for primary prevention in high-risk individuals, in whom the strategy is cost-effective and the benefits exceed the risks. Whether primary prevention is beneficial in individuals at low or moderate risk is not certain. Therefore, the prescription of statins for primary prevention should be individualized on the basis of clinical judgment, particularly for low-risk individuals. In appropriately selected individuals, statins should also be used for primary prevention of ischaemic stroke and transient ischaemic attack.
authors.affiliation: Department of Internal Medicine, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia. zreiner@kbc-zagreb.hr
authors.forename: Željko
authors.initials: Ž
authors.lastname: Reiner
mesh_terms: D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D050171:Dyslipidemias / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D019317:Evidence-Based Medicine; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D018579:Patient Selection; D011322:Primary Prevention / Q000191:economics / Q000379:methods*; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors