title: Refining Statin Prescribing in Lower-Risk Individuals: Informing Risk/Benefit Decisions.
abstract: Guidelines from the American College of Cardiology/American Heart Association, as well as those from the Veterans Affairs/Department of Defense and the Joint British Societies all recommended treating more people with statins than previous guidelines. In each guideline, the decision-making process began with an assessment of overall cardiovascular risk. Each group proposed updated treatment thresholds, and all of them lowered the threshold compared with earlier guidelines. Since release of these new guidelines in 2013 and 2014, additional evidence has emerged to suggest a rationale for extending statin consideration to an even larger proportion of asymptomatic adults-even those with a 10-year atherosclerotic cardiovascular disease risk below 7.5%. This review discusses new findings since 2013 and proposes strategies emanating from the current guidelines to help clinicians and patients make more informed decisions about long-term statin use, especially pertinent to lower-risk patients.
authors.affiliation: Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Ashley
authors.initials: A
authors.lastname: Pender
authors.affiliation: Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Donald M
authors.initials: DM
authors.lastname: Lloyd-Jones
authors.affiliation: Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Stone
authors.affiliation: Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Electronic address: p-greenland@northwestern.edu.
authors.forename: Philip
authors.initials: P
authors.lastname: Greenland
mesh_terms: D000066491:Clinical Decision-Making; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D011307:Drug Prescriptions / Q000592:standards; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D018570:Risk Assessment
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: atherosclerotic cardiovascular disease; coronary artery calcium; cost effectiveness; primary prevention