When individuals were presented with risk and benefit information about statins, they required 50-75% relative reduction in risk in order to find taking a statin acceptable.Statins provide a 25% relative reduction per 38.61 mg/dL reduction in LDL cholesterol. At that level, only about a quarter or one-third of individuals would be willing to take a statin if they had a baseline atherosclerotic cardiovascular disease risk of 10% or more over 10 years.The findings give underscore the importance of communicating absolute risks and benefits of statins to help inform patients who may weigh these risks and benefits differently than the medical community does.

Most people surveyed wouldn’t be willing to take statins at their actual efficacy levels in primary prevention, according to a study with implications for shared decision-making.

When informed about potential adverse events and the burden of associated costs and healthcare visits, the smallest absolute risk reduction respondents would be willing to accept in order to take a statin (aka smallest worthwhile difference) was 7.5% at a hypothetical 10-year atherosclerotic cardiovascular disease (ASCVD) risk of 10%. They required an absolute 10.0% reduction if baseline risk was 20% over 10 years, Yan Luo, MD, PhD, of the University of Tokyo Graduate School of Medicine, and colleagues reported in JAMA Internal Medicine.

Actual efficacy levels of statins can’t match those demands for a 50-75% relative reduction in risk.

With the 25% relative risk reduction per 38.61 mg/dL reduction in LDL cholesterol shown in trials, only 13.8%, 23.6%, and 34.2% of Americans surveyed said they would be willing to accept a statin at a 2%, 10%, or 20% 10-year baseline ASCVD risk. The numbers were similar among Japanese respondents.

The findings point to “discrepancies between patient and specialist perspectives,” the researchers said, as current guidelines recommend statins for primary prevention in patients with a 10-year ASCVD risk of 7.5% or higher, and treatment thresholds as low as 3-5% have been proposed when using the newer PREVENT risk calculator.

The data call for renewed efforts at shared decision-making as part of risk-benefit discussions, said an accompanying editorial by Ilana B. Richman, MD, MHS, of Yale School of Medicine in New Haven, Connecticut, and colleagues. While this is recommended by guidelines, “minimal guidance is provided to clinicians on how to conduct shared decision-making and these discussions can be of variable quality and depth,” they noted.

“Findings from this study underscore the importance of communicating the absolute risks and benefits of statins to help inform patients who may weigh these risks and benefits differently,” they added. “Use of structured decision aids can help guide quantitative discussions of risk and ensure that patients have adequate information for informed decision-making. As guidelines move toward lower risk thresholds and expand the populations for whom statins for primary prevention are recommended, understanding and honoring patients’ preferences will remain essential.”

The study used online surveys of 602 U.S. and 665 Japanese respondents ages 40-75 years with no prior statin use who were recruited through research crowdsourcing panels with stratified sampling to approximate national demographics. The researchers provided explanations of benefits and burdens of statin treatment, encompassing known adverse effects, costs, and inconvenience, and then did two comprehension checks.

Only the 254 U.S. and 297 Japanese individuals (42% and 45%, respectively) who correctly answered those questions indicating basic understanding of statins were eligible to complete the survey.

At 2% baseline risk, which is below the current guideline-indicated threshold for routinely recommending statins, 75.6% of U.S. and 62.3% of Japanese respondents declined statins under the scenario that their risk would drop to 0.

At a hypothetical 10% baseline risk, 42.9% of U.S. and 42.4% of Japanese respondents said they would not be willing to take a statin. That rate was still 23.6% and 38.4%, respectively, when the hypothetical 10-year risk was raised to 20%.

Limitations of the study cited by the researchers included bias from online sampling and simplified assumptions regarding the current efficacy of statins.

“Even for well-established treatments like statins, gaps may exist between public expectations and guideline recommendations,” they concluded. The concept of smallest worthwhile difference as they reported it “may help incorporate patient preferences into guidelines and support effective communication frameworks for shared decision-making.”