Statins for prevention by age
For adults 40 to 75 with at least one heart risk factor and a 10-year risk of 10% or more, the USPSTF recommends starting a statin (grade B, 2022). Between 7.5% and 10% it is a selective offer, and from 76 the evidence is not enough to decide. (USPSTF, 2022)
This page is about preventing a first heart attack or stroke. The recommendation does not cover people who already have heart disease, an LDL cholesterol above 190 mg/dL or familial hypercholesterolemia. (USPSTF, 2022) Do not start or stop a statin without talking to your doctor.
- USPSTF grade
- B, C or I by risk and age
- Who
- Adults with a heart risk factor
- Ages
- 40 to 75
- Risk tool
- ACC/AHA Pooled Cohort Equations
Statins by age and 10-year risk
| Who | USPSTF grade | What it means |
|---|---|---|
| 40 to 75, one or more risk factors, 10-year risk 10% or more | B | Start a statin |
| 40 to 75, one or more risk factors, 10-year risk 7.5% to under 10% | C | Offer selectively: the benefit is smaller, so your preferences count |
| 76 and older | I | Evidence not enough to decide on starting a statin |
The risk factors the USPSTF names are abnormal cholesterol (dyslipidemia), diabetes, high blood pressure and smoking. The recommendation applies to adults 40 or older who do not already have heart disease or its signs or symptoms. (USPSTF, 2022)
When a statin is started under the grade B, the USPSTF describes a moderate-intensity statin, after the clinician explains why and the patient agrees. Dose and choice of drug are for your doctor. (USPSTF, 2022)
How the 10-year risk number is worked out
The USPSTF says the ACC/AHA Pooled Cohort Equations may be used. They take age, sex, race (Black or not), cholesterol levels, systolic blood pressure, blood pressure treatment, diabetes and smoking, and estimate the chance of a heart attack or stroke in the next 10 years. (USPSTF, 2022)
Your clinician works it out with your own numbers. A cholesterol test gives the values it needs. Read more: cholesterol test by age.
Where the ACC/AHA differs
| 10-year risk | USPSTF (2022) | ACC/AHA (2018, 2019) |
|---|---|---|
| 20% or more | Start, with a risk factor (B) | High risk: start a statin |
| 10% to under 20% | Start, with a risk factor (B) | Intermediate risk: start a statin |
| 7.5% to under 10% | Offer selectively (C) | Intermediate risk: start a statin |
| 5% to under 7.5% | No recommendation to start | Borderline risk: talk it through; risk enhancers can tip the decision |
The main gap is at 7.5% to 10%, where the ACC/AHA advises starting and the USPSTF calls it a selective offer. The ACC/AHA risk enhancers include early heart disease in the family, chronic kidney disease, metabolic syndrome, preeclampsia, early menopause, inflammatory diseases, HIV and South Asian ancestry. (USPSTF, 2022)
Questions people ask
At what age should you start a statin?
The USPSTF recommendation begins at 40, but age alone is not the reason. It applies when you also have at least one risk factor and a 10-year heart risk of 10% or more (grade B), or 7.5% to under 10% as a selective offer (grade C). (USPSTF, 2022)
Should I start a statin after 75?
The USPSTF found the evidence insufficient on starting a statin at 76 or older (grade I). Its statement is about starting one, not stopping one you already take. Talk to your doctor. (USPSTF, 2022)
Does this apply if I already had a heart attack or stroke?
No. The recommendation covers adults who do not have heart disease or its signs or symptoms. If you already have heart disease, your treatment is a question for your doctor. (USPSTF, 2022)
What if my LDL cholesterol is very high?
The recommendation does not apply to an LDL cholesterol above 190 mg/dL or known familial hypercholesterolemia. The USPSTF calls these groups very high risk and points to other organizations' guidelines for them. (USPSTF, 2022)
This page explains what the guidelines say. It cannot tell you what is right for you: talk to your doctor.