Statin Users Retain Substantial ASCVD Risk

Adults receiving statin therapy continued to experience atherosclerotic cardiovascular disease (ASCVD) events, particularly those with established ASCVD, according to a systematic review and meta-analysis published in the Journal of the American Heart Association.

Investigators reviewed observational studies published from January 1, 2013, through August 1, 2023, that reported cardiovascular outcomes among adult statin users. The review identified 77 publications representing 76 unique studies. Depending on the outcome, up to 11 studies met the criteria for inclusion in the individual meta-analyses.

The pooled incidence of the composite outcome—major adverse cardiovascular events or all-cause death—was 12.3 per 1000 person-years, with study-level rates ranging from 0.2 to 72.0 per 1000 person-years. The rate was 6.4 per 1000 person-years among adults at risk for ASCVD and 15.8 per 1000 person-years among those with prior ASCVD.

Across the overall population, the pooled incidence rates were 8.3 per 1000 person-years for myocardial infarction, 6.0 per 1000 person-years for ischemic stroke, 4.3 per 1000 person-years for cardiovascular-related death, and 7.4 per 1000 person-years for coronary revascularization. Sensitivity analyses excluding studies with selected high-risk populations produced lower estimates, including 7.0 per 1000 person-years for the composite outcome and 2.7 per 1000 person-years for myocardial infarction.

The investigators cautioned that study-level estimates varied substantially, with heterogeneity exceeding 95% for most pooled analyses. Additional limitations included the predominantly retrospective evidence base, variable ASCVD definitions and inconsistent reporting of statin therapy intensity, limited information about treatment adherence and low-density lipoprotein cholesterol goal attainment, and possible event misclassification.

Source: Watanabe AH, Bash LD, Westley T, et al. Residual atherosclerotic cardiovascular disease risk in statin users: a systematic review and meta-analysis. J Am Heart Assoc. Published online August 20, 2026. doi:10.1161/JAHA.125.044840