Here are the four major primary and secondary prevention patient groups which the guidelines advocate who should be treated with statins to reduce the risk of atherosclerotic cardiovascular disease (ASCVD)
- Individuals with clinical ASCVD
- Individuals with LDL-cholesterol of levels > 190mg/dL, such as those with familial hypercholesterolemia
- Individuals with diabetes aged 40-75 years old with LDL-cholesterol levels between 70-189 mg/dL and without evidence of ASCVD
- Individuals without evidence of ASCVD or DM but who have a LDL-cholesterol levels between 70-189 mg/dL and a 10-year risk of ASCVD > 7.5%
The evidence supporting the first three groups of patients is significant and noncontroversial.
There is significant controversy regarding the fourth group. Some are writing that this recommendation is too narrow. Others are writing that this recommendation is too broad. Many have issues with the risk calculator which is used to calculate the 10-year risk. The guidelines do advocate using novel strategies for further helping to define risk (hsCRP, calcium score by CT scan, carotid intimal thickness by ultrasound) - which I have been using for a few now. I also believe that in treating younger patients, its vital not to just look at their 10-year risk but their lifetime risk of ASCVD.
Always remember, that these are just recommendations and not law and that it is always imperative to discuss the risk assessment and medical therapy with your physician.