2016 US Preventive Services Task Force Statin Guidelines With Links To The References

 

This blog is simply my peripheral brain organized so that I can easily retrieve medical information that I want to be able to quickly access.

So that’s why I’ve included  the reference list from Reference (1). These footnotes basically include almost every important article relevant to cholesterol decision making in the past three years.

What follows are excerpts from Reference (1), Statin Use For Primary Prevention of Cardiovascular Disease in Adults United States Preventive Services Task Force Recommendation Statement 2016:

CONCLUSIONS AND RECOMMENDATIONS

The USPSTF recommends initiating use of low- to moderate-dose statins in adults aged 40 to 75 years without a history of CVD who have 1 or more CVD risk factors (dyslipidemia, diabetes, hypertension, or smoking) and a calculated 10-year CVD event risk of 10% or greater (B recommendation).

The USPSTF recommends that clinicians selectively offer low- to moderate-dose statins to adults aged 40 to 75 years without a history of CVD who have 1 or more CVD risk factors and a calculated 10-year CVD event risk of 7.5%to 10% (C recommendation).

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of initiating statin use in adults 76 years and older (I statement).

Identification of dyslipidemia and calculation of 10-year CVD
event risk requires universal lipids screening in adults aged40 to 75 years. See the “Clinical Considerations” section for more information on lipids screening and the assessment of cardiovascular risk.

Statins are a class of lipid-lowering medications that function
by inhibiting the enzyme 3-hydroxy-3-methyl-glutaryl coenzymeA reductase, which is involved in the rate-limiting step in the productionof cholesterol. Statins  reducelevels of total cholesterol and LDL-C and, to a lesser extent, triglycerides, and probably have antiinflammatory and plaque stabilization effects as well.6

The USPSTF found adequate evidence that the harms of low- to moderate-dose statin use in adults aged 40 to 75 years are small.

Risk Factors for CVD
For the purposes of this recommendation, dyslipidemia is defined as an LDL-C level greater than 130mg/dL or a high-density lipoprotein cholesterol (HDL-C) level less than40mg/dL (to convertHDL-C values to mmol/L, multiply by 0.0259). Most participants enrolled in trials of statin use for the prevention of CVD had an LDL-C level of 130 to 190 mg/dL or a diabetes diagnosis; hypertension and smoking were also common among trial participants.6  Persons with an LDL-C level greater than 190mg/dL were usually excluded from trial participation, as it was not considered appropriate to randomly assign them to placebo. Thus, these recommendations do not pertain to persons with very high cholesterol levels (ie,LDL-C>190mg/dL) or familialhypercholesterolemia, as they were excluded from most prevention trials.

fig1

 

Resources:

(1) Statin Use for the Primary Prevention of Cardiovascular Disease in Adults
US Preventive Services Task Force Recommendation Statement [PubMed Abstract] [Full Text HTML]. JAMA. 2016 Nov 15;316(19):1997-2007. doi: 10.1001/jama.2016.15450.*

(2) Statins for Primary Prevention: The Debate Is Intense, but the Data Are Weak. [PubMed Citation] [Full Text HTML]. JAMA. 2016 Nov 15;316(19):1979-1981. doi: 10.1001/jama.2016.15085.

(3) Interpretation and Use of Another Statin Guideline. [PubMed Abstract] [Full Text HTML]. JAMA. 2016 Nov 15;316(19):1977-1979. doi: 10.1001/jama.2016.15087.

*The following are the citations from Reference (1) above:

References

1.

Goff  DC  Jr, Lloyd-Jones  DM, Bennett  G,  et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines.  2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25)(suppl 2):S49-S73.
PubMed Article

2.

Rana  JS, Tabada  GH, Solomon  MD,  et al.  Accuracy of the atherosclerotic cardiovascular risk equation in a large contemporary, multiethnic population. J Am Coll Cardiol. 2016;67(18):2118-2130.
PubMed Article

3.

Cook  NR, Ridker  PM.  Further insight into the cardiovascular risk calculator: the roles of statins, revascularizations, and underascertainment in the Women’s Health Study. JAMA Intern Med. 2014;174(12):1964-1971.
PubMed Article

4.

DeFilippis  AP, Young  R, Carrubba  CJ,  et al.  An analysis of calibration and discrimination among multiple cardiovascular risk scores in a modern multiethnic cohort. Ann Intern Med. 2015;162(4):266-275.
PubMed Article

5.

Mensah  GA, Brown  DW.  An overview of cardiovascular disease burden in the United States. Health Aff (Millwood). 2007;26(1):38-48.
PubMedArticle

6.

Chou  R, Dana  T, Blazina  I,  et al. Statin Use for the Prevention of Cardiovascular Disease in Adults: A Systematic Review for the US Preventive Services Task Force: Evidence Synthesis No. 139. Rockville, MD: Agency for Healthcare Research and Quality; 2016. AHRQ publication 14-05206-EF-2.

7.

Richardson  K, Schoen  M, French  B,  et al.  Statins and cognitive function: a systematic review. Ann Intern Med. 2013;159(10):688-697.
PubMed Article

8.

Yusuf  S, Bosch  J, Dagenais  G,  et al; HOPE-3 Investigators.  Cholesterol lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med. 2016;374(21):2021-2031.
PubMed Article

9.

Chou  R, Dana  T, Blazina  I, Daeges  M, Jeanne  T.  Statins for prevention of cardiovascular disease in adults: a systematic review and meta-analysis for the US Preventive Services Task Force. JAMA. doi:10.1001/jama.2015.15629

10.

Ridker  PM, Danielson  E, Fonseca  FA,  et al; JUPITER Study Group.  Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008;359(21):2195-2207.
PubMed Article

11.

Buckley  DI, Fu  R, Freeman  M, Rogers  K, Helfand  M.  C-reactive protein as a risk factor for coronary heart disease: a systematic review and meta-analyses for the U.S. Preventive Services Task Force. Ann Intern Med. 2009;151(7):483-495.
PubMed Article

12.

U.S. Preventive Services Task Force.  Using nontraditional risk factors in coronary heart disease risk assessment: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;151(7):474-482.
PubMed Article

13.

American Heart Association, American College of Cardiology. Pooled Cohort Equations Cardiovascular Risk Calculator. 2014. https://tools.acc.org/ASCVD-Risk-Estimator/. Accessed September 16, 2016.

14.

Ridker  PM, Cook  NR.  Statins: new American guidelines for prevention of cardiovascular disease. Lancet. 2013;382(9907):1762-1765.
PubMed Article

15.

Helfand  M, Buckley  DI, Freeman  M,  et al.  Emerging risk factors for coronary heart disease: a summary of systematic reviews conducted for the U.S. Preventive Services Task Force. Ann Intern Med. 2009;151(7):496-507.
PubMed Article

16.

Dehmer  SP, Maciosek  MV, Flottemesch  TJ. Aspirin Use to Prevent Cardiovascular Disease and Cancer: A Decision Analysis. Rockville, MD: Agency for Healthcare Research and Quality; 2015. AHRQ publication 15-05229-EF-1.

17.

Siu  AL; U.S. Preventive Services Task Force.  Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2015;163(10):778-786.
PubMed Article

18.

Siu  AL; US Preventive Services Task Force.  Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2015;163(8):622-634.
PubMed Article

19.

Chou  R, Dana  T, Blazina  I, Daeges  M, Bougatsos  C, Jeanne  T. Screening for Dyslipidemia in Younger Adults: A Systematic Review to Update the 2008 US Preventive Services Task Force Recommendation: Evidence Synthesis No. 138. Rockville, MD: Agency for Healthcare Research and Quality; 2016. AHRQ publication 14-05206-EF-1.

20.

Chou  R, Dana  T, Blazina  I, Daeges  M, Bougatsos  C, Jeanne  TL.  Screening for dyslipidemia in younger adults: a systematic review for the US Preventive Services Task Force. Ann Intern Med. 2016;165(8):560-564.
PubMed Article

21.

Bibbins-Domingo  K, Grossman  DC, Curry  SJ,  et al; US Preventive Services Task Force.  Screening for lipid disorders in children and adolescents: US Preventive Services Task Force recommendation statement. JAMA. 2016;316(6):625-633.
PubMed Article

22.

Versmissen  J, Oosterveer  DM, Yazdanpanah  M,  et al.  Efficacy of statins in familial hypercholesterolaemia: a long term cohort study. BMJ. 2008;337:a2423.
PubMed Article

23.

Downs  JR, Clearfield  M, Weis  S,  et al.  Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. JAMA. 1998;279(20):1615-1622.
PubMed Article

24.

Stone  NJ, Robinson  JG, Lichtenstein  AH,  et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines.  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. Circulation. 2014;129(25)(suppl 2):S1-S45.
PubMed Article

25.

Mihaylova  B, Emberson  J, Blackwell  L,  et al; Cholesterol Treatment Trialists’ (CTT) Collaborators.  The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet. 2012;380(9841):581-590.
PubMed Article

26.

Ridker  PM, Pradhan  A, MacFadyen  JG, Libby  P, Glynn  RJ.  Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: an analysis from the JUPITER trial. Lancet. 2012;380(9841):565-571.
PubMed Article

27.

Schatz  IJ, Masaki  K, Yano  K, Chen  R, Rodriguez  BL, Curb  JD.  Cholesterol and all-cause mortality in elderly people from the Honolulu Heart Program: a cohort study. Lancet. 2001;358(9279):351-355.
PubMed Article

28.

Weverling-Rijnsburger  AW, Blauw  GJ, Lagaay  AM, Knook  DL, Meinders  AE, Westendorp  RG.  Total cholesterol and risk of mortality in the oldest old. Lancet. 1997;350(9085):1119-1123.
PubMed Article

29.

Gu  Q, Paulose-Ram  R, Burt  VL, Kit  BK.  Prescription cholesterol-lowering medication use in adults aged 40 and over: United States, 2003-2012. NCHS Data Brief. 2014;(177):1-8.
PubMed

30.

Johansen  ME, Green  LA.  Statin use in very elderly individuals, 1999-2012. JAMA Intern Med. 2015;175(10):1715-1716.
PubMed Article

31.

AMDA—The Society for Post-Acute and Long-Term Care Medicine. Ten things physicians and patients should question. https://www.choosingwisely.org/societies/amda-the-society-for-post-acute-and-long-term-care-medicine/. 2015. Accessed September 16, 2016.

32.

Bibbins-Domingo  K; U.S. Preventive Services Task Force.  Aspirin Use for the Primary Prevention of Cardiovascular Disease and Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2016;164(12):836-845.
PubMed Article

33.

Moyer  VA; U.S. Preventive Services Task Force.  Screening for coronary heart disease with electrocardiography: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;157(7):512-518.
PubMed

34.

Siu  AL; U S Preventive Services Task Force.  Screening for abnormal blood glucose and type 2 diabetes mellitus: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2015;163(11):861-868.
PubMed Article

35.

Moyer  VA; U.S. Preventive Services Task Force.  Behavioral counseling interventions to promote a healthful diet and physical activity for cardiovascular disease prevention in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;157(5):367-371.
PubMed

36.

Moyer  VA; U.S. Preventive Services Task Force.  Screening for and management of obesity in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;157(5):373-378.
PubMed

37.

Hoyert  DL, Xu  J.  Deaths: preliminary data for 2011. Natl Vital Stat Rep. 2012;61(6):1-51.
PubMed

38.

Miniño  AM.  Death in the United States, 2011. NCHS Data Brief. 2013;(115):1-8.
PubMed

39.

Centers for Disease Control and Prevention (CDC).  Prevalence of coronary heart disease—United States, 2006-2010. MMWR Morb Mortal Wkly Rep. 2011;60(40):1377-1381.
PubMed

40.

Sever  PS, Dahlöf  B, Poulter  NR,  et al; ASCOT Investigators.  Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet. 2003;361(9364):1149-1158.
PubMed Article

41.

Jick  SS, Bradbury  BD.  Statins and newly diagnosed diabetes. Br J Clin Pharmacol. 2004;58(3):303-309.
PubMed Article

42.

Culver  AL, Ockene  IS, Balasubramanian  R,  et al.  Statin use and risk of diabetes mellitus in postmenopausal women in the Women’s Health Initiative. Arch Intern Med. 2012;172(2):144-152.
PubMed Article

43.

Lopez-Jimenez  F, Simha  V, Thomas  RJ,  et al.  A summary and critical assessment of the 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular disease risk in adults: filling the gaps. Mayo Clin Proc. 2014;89(9):1257-1278.
PubMed Article

44.

Anderson  TJ, Grégoire  J, Hegele  RA,  et al.  2012 update of the Canadian Cardiovascular Society guidelines for the diagnosis and treatment of dyslipidemia for the prevention of cardiovascular disease in the adult. Can J Cardiol. 2013;29(2):151-167.
PubMed Article

45.

National Institute for Health and Care Excellence. Cardiovascular disease: risk assessment and reduction, including lipid modification. https://www.nice.org.uk/Guidance/CG181. 2016. Accessed September 16, 2016.
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