# Statin Use for the Primary Prevention of Cardiovascular Disease in Adults

## Purpose of the Protocol
To update the 2016 recommendation regarding the use of statins for reducing cardiovascular disease (CVD)-related morbidity, mortality, and all-cause mortality.

## Target Population
- Adults aged >= 40 and without a history of known cardiovascular disease (CVD).
- Adults who do not show signs or symptoms of CVD.

## Recommendations
* For Adults Aged 40 to 75 Years with ≥1 CVD Risk Factors
    -  If age >= 40 and < 76 and CVD risk factors == dyslipidemia, diabetes, hypertension, smoking and 10-year CVD event risk >= 10%:
        - Initiate a statin (Grade B recommendation).
    - If age >= 40 and < 76 and CVD risk factors == dyslipidemia, diabetes, hypertension, smoking and 10-year CVD event risk >= 7.5% and < 10%:
        - Selectively offer a statin (Grade C recommendation).

## Importance
- Cardiovascular disease (CVD) is the leading cause of morbidity and death in the US.
- CVD accounts for more than 1 in 4 deaths.
- In 2019, an estimated 558,000 deaths were due to coronary heart disease.
- In 2019, approximately 109,000 deaths were caused by ischemic stroke.
- Men have higher overall prevalence and mortality from CVD.
- Women experience higher mortality from certain cardiovascular events like stroke.
- Black adults have the highest prevalence of CVD among different races and ethnicities.

## Conclusion
Initiating statin therapy for the primary prevention of CVD events and all-cause mortality in adults aged 40 to 75 years with no history of CVD, who have one or more risk factors such as dyslipidemia, diabetes, hypertension, or smoking, and an estimated 10-year CVD event risk of 10% or greater, has at least a moderate net benefit. For those aged 40 to 75 years with a 10-year CVD event risk of 7.5% to less than 10%, the likelihood of benefit is smaller, and clinicians should selectively offer statins. Evidence is insufficient to determine the benefits and harms of statin use in adults aged 76 years or older for primary prevention.