Author + information
- Lionel H. Opie, MD, DPhil∗ ()
- ↵∗Hatter Institute for Cardiovascular Research in Africa, University of Cape Town Medical School, Observatory, 7925 Cape Town, South Africa
Ridker et al. (1) draw attention to the importance of statins as primary prevention agents; they endorse pharmacological treatment for those patients who have estimated 10-year risks ≥7.5% and for whom trial-based evidence supports statin efficacy. In addition, the 5-year risk for statin-treated patients had a relative risk of 0.62 (95% confidence interval: 0.47 to 0.81). Another important point they highlight is the effect of age (Figure 4 in Ridker et al. ). They warn against overestimation of the 10-year risk, implying that primary prevention is overused at present.
There is, however, an alternate way of looking at indications for the use of statins for primary prevention, on the basis of the initial level of low-density lipoprotein cholesterol (LDL-C) as shown in the lower part of Figure 1(2). This approach shows that the higher the initial pre-treatment LDL-C level, the greater the effect of statin therapy and the greater the reduction in 10-year mortality (Figure 1). For primary prevention by a statin, a pre-treatment LDL-C level of 200 mg% (approximately 5 mmol/l) would substantially reduce the 10-year risk of a coronary heart disease event, whereas starting statin therapy at an initial level of 120 mg% would provide only slight improvement in the reduction of absolute risk. Thus, the absolute pre-therapy LDL-C level could be crucial in deciding whether to prescribe a statin.
Please note: Dr. Opie has reported that he has no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation