The US Preventive Services Task Force (USPSTF) has issued an update to its 2008 recommendation on screening for lipid disorders in adults. This recommendation statement focuses on statin use for the primary prevention of cardiovascular disease (CVD) in adults. Among the USPSTF recommendations:

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

• Clinicians should choose to offer low- to moderate-dose statins to adults aged 40 to 75 years without a history of CVD who have ≥1 CVD risk factors and a calculated 10-year CVD event risk of 7.5% to 10% (C recommendation).

• Current evidence is insufficient to assess the balance of benefits and harms of initiating statin use in adults aged ≥76 years (I statement).

Citation: Bibbins-Domingo, Grossman DC, Curry SJ, et al. Statin use for the primary prevention of cardiovascular disease in adults. JAMA. 2016;316(19):1997-2007. doi:10.1001/jama.2016.15450.

Commentary: Nineteen randomized controlled trials have confirmed the benefits of statins in the primary prevention of CV disease. This statement by USPSTF defines which groups benefit optimally from primary prevention of CV disease. It is important to understand that the USPSTF explicitly acknowledges some of the imprecision around the edges of the recommendations. This is particularly important for two groups. The first is older individuals without CV risk factors. The USPSTF states, “Many older adults, particularly those aged 65 to 75 years, may meet the recommended risk threshold for treatment with statins in spite of the absence of dyslipidemia, diabetes, hypertension, or smoking. No trial data evaluated statin use among persons in this age group without CVD risk factors; thus, the evidence is insufficient to know whether statin use provides them the same or less benefit than in similarly aged adults with CVD risk factors.” Here, clinicians should use their judgment and engage patients in shared decision making. The other group is younger adults. While the USPSTF does not recommend screening adults aged 20 to 39 years, it acknowledges that the rationale for treating individuals in this group who are at high risk is to prevent the development of increased atherosclerosis. As there is a lack of data on efficacy of screening and treatment, clinicians are encouraged to “use their clinical judgment” for this group. —Neil Skolnik, MD