When statins can be avoided in high-risk groups

Statin therapy may not be necessary in high-risk patients if calcium buildup is absent, US cardiologists say.

Their research shows this group has less than a 3% chance of a cardiovascular event over the next decade even with well-known risk factors, such as diabetes, hypertension or high LDL levels.

The authors note that this is well below the 7.5% level set by the American College of Cardiology and American Heart Association as a guideline to begin statin treatment.

Their findings suggest that those with a coronary artery calcium (CAC) score of zero may be able to forgo statin treatment.

At least half of those in their study of more than 6000 older adults showed no calcium deposits.

However, the authors caution that a zero CAC score doesn’t mean that plaque buildup won’t happen or that the patient has zero risk.

Rather, it means their risk of MI or stroke is lower than the threshold typically recommended for statin treatment, says lead author and preventive cardiologist Dr Parag Joshi, who is based in Dallas, US.

A 5% risk — factoring in age, sex, ethnicity, smoking, diabetes, high blood pressure, and cholesterol levels — is considered the low end for recommending statin use, he adds.

Despite the findings, Dr Joshi says there may still be an argument for starting statin treatment before there is evidence of calcium buildup.