Targeting Patients for Statin Therapy for the Primary Prevention of Vascular Events: What is the Best Approach?

The optimal strategy for targeting patients for interventions for the primary prevention of cardiovascular events could be considered a central objective of personalized medicine, and the consideration of cost-effectiveness in the process of identifying the best screening strategy is a cornerstone of efficient and responsible health policy in the current era. Starting with the introduction of lovastatin in the mid 1980s, several large clinical trials have demonstrated the efficacy of statins with respect to the prevention of coronary events in patients with established vascular disease or at moderate to high risk of cardiovascular events, while also demonstrating a favorable safety profile. Indeed, statins are one of the most highly studied and prescribed medications. More recently, attention has turned to the primary prevention setting, with recognition of the fact that nearly half of all coronary events occur in patients without overt hyperlipidemia. Results from key studies, including the Heart Protection Study1 and meta analyses,2 suggest that the threshold for initiation of statin therapy should be lowered, and the optimal strategy for identifying patients for whom there is an expected net benefit with statin therapy is now actively debated.Article see p 1478Results from the Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) trial3 brought this issue to the fore; the highly significant and large magnitude of effect of rosuvastatin on the primary end point of vascular events patients with normal low-density lipoprotein cholesterol but elevated high-sensitivity C-reactive protein (hs-CRP) suggest a potential role for hs-CRP screening in moderate- to low-risk patients who would not otherwise meet criteria for statins according to Adult Treatment Panel III (ATP-III) guidelines. Studies have shown that elevated hs-CRP is associated with an increased risk of future vascular risk, even among patients with low to normal …