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During routine yearly physicals, primary care providers often evaluate serum laboratory lipid levels. Many of these patients have no past medical history of cardiovascular events related to atherosclerotic disease. Some patients do not have secondary risk factors, such as diabetes mellitus or smoking history.
Previous cardiovascular events provide stronger indications for the use of HMG-CoA reductase inhibitors (statins). In the absence of these, the provider may turn to current guidelines, in this case the 2013 the American College of Cardiology and the American Heart Association published the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults.
There is however, controversy, even within the evidence to this guideline, about the effect of statins in primary prevention with respect to the reduction that they have on all-cause mortality. There are many factors that could influence the use of statin therapy for primary prevention. These could include non-fatal myocardial infarction, non-fatal cerebral vascular accident, among others. One of the biggest factors is all-cause mortality.
A review of the evidence cited for these guidelines demonstrates that the majority of the clinical trials did not show a reduction in all-cause mortality, in primary prevention. It is important to understand that this evidence comes directly from the same evidence that the ACC/AHA used to create the primary prevention guidelines.
Physician Assistant Studies
Master of Physician Assistant Studies (MPAS)
Jay Metzger, PA-C
Jeremy Hopkin, MD
Douglas Callahan, DO
Hydroxymethylglutaryl-CoA Reductase Inhibitors -- therapeutic use
Cardiovascular Diseases | Primary Care
Adams, Brian, "The Effect of Statins in Primary Prevention on All-Cause Mortality" (2017). Physician Assistant Scholarly Project Posters. 29.