Author + information
- Received October 21, 2014
- Revision received December 9, 2014
- Accepted December 14, 2014
- Published online March 10, 2015.
- Paul M Ridker, MD, MPH∗ (, )
- Lynda Rose, BS and
- Nancy R. Cook, ScD
- ↵∗Reprint requests and correspondence:
Dr. Paul M Ridker, Center for Cardiovascular Disease Prevention, Brigham and Women’s Hospital, 900 Commonwealth Avenue East, Boston, Massachusetts 02215.
Current algorithms for statin allocation in primary prevention use epidemiologic estimates of absolute risk. However, a global risk prediction score has not been used as an enrollment criterion in any randomized trial of statin therapy. Moreover, completed statin trials show greater relative risk reductions for those patients at lower levels of absolute risk. Thus, risk calculators that rely solely on epidemiologic modeling do not ensure that those who will benefit are selected for treatment. We propose a hybrid approach to statin prescription for apparently healthy men and women that strongly endorses pharmacologic treatment for those who have estimated 10-year risks ≥7.5% and for whom trial-based evidence supports statin efficacy in primary prevention. Although individuals could still be treated on the basis of absolute risk alone, the hybrid approach is evidence-based, is easily applied in clinical practice, and may increase the transparency of physician–patient interactions concerning prescription of statin therapy in primary prevention.
- hydroxymethylglutaryl CoA reductase inhibitors
- myocardial infarction
- primary prevention
- risk factors
Dr. Ridker is listed as a coinventor on patents held by the Brigham and Women’s Hospital that relate to the use of inflammatory biomarkers in cardiovascular disease and diabetes and that have been licensed to AstraZeneca and Siemens; and has received research grant support from AstraZeneca and Pfizer, Inc., manufacturers of statin therapy. Drs. Rose and Cook have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 21, 2014.
- Revision received December 9, 2014.
- Accepted December 14, 2014.
- American College of Cardiology Foundation