Effectiveness of Statins as Primary Prevention in People With Different Cardiovascular Risk: A Population‐Based Cohort Study

The purpose was to analyze statin effectiveness in a general population with differing levels of coronary heart disease (CHD) risk. Patients (35–74 years) without previous cardiovascular disease were included and stratified according to 10‐year CHD risk (<5%, 5–7.4%, 7.5–9.9%, and 10–19.9%). New users were categorized according to their medical possession ratio (MPR). The main outcome was atherosclerotic cardiovascular disease (ASCVD) (myocardial infarction and ischemic stroke). In adherent patients (MPR 70%), statin treatment decreased ASCVD risk across the range of coronary risk (from 16–30%). The 5‐year number needed to treat (NNT) was 470 and 204 in the risk categories <5% and 5–7.4%, respectively, and 75 and 62 in the 7.5–9.9% category than in the 10–19.9% category, respectively. Statin therapy should remain a priority in patients at high 10‐year CHD risk (10–19.9%). Most patients with intermediate risk could benefit from statin treatment, but the treatment decision should focus on the net benefit, safety, and patient preference, given the higher NNT.