Benefits and limitations of statin use in primary cardiovascular prevention:recent advances

The status of low-density lipoprotein (LDL) cholesterol is strong as an essential cause of atherosclerotic vascular disease (ASCVD) and primary target of lipid lowering. Drugs affecting primarily LDL cholesterol through an increase of LDL receptor expression are the backbone of current therapy, and generic statins are generally safe, effective, and inexpensive drugs serving this purpose. Statins are indicated for practically all patients in secondary prevention, whereas treatment in primary prevention (healthy individuals) is based on a calculated 10-year risk of ASCVD. At “borderline” (from 5% to <⁠7.5%) and “intermediate” (from 7.5% to <⁠20%) risk various biomarkers (eg, coronary artery calcium) are available for accurate assessment of the individual risk. The calculation of a lifetime risk instead of the 10-year risk can be especially useful in younger people. More information about the benefits and risks of statins in primary prevention in older people (>70 years of age) will be provided by ongoing randomized and controlled trials (STAREE and PREVENTABLE). In this narrative review, I shall present recent advances in the use of statins in younger and older healthy people, and discuss their benefits and potential risks. I also raise a question whether with the current evidence base, most people in affluent societies would benefit from taking statins.