Minimum Absolute Risk Reduction Required by Patients for Statin Adherence

Article Impact Level: HIGH
Data Quality: STRONG
Summary of  JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2025.7958  
Dr. Yan Luo  et al.

Points

Researchers used the smallest worthwhile difference metric to survey over five hundred adults and found that most patients expect much higher risk reduction from statins than the drugs actually provide.
At a moderate ten percent risk level over forty percent of participants in both the United States and Japan declined to take daily medication despite knowing its clinical benefits.
Participants across both countries typically expected statins to reduce their ten year cardiovascular risk by at least seven point five percentage points before they would consider the treatment worthwhile.
The study revealed that at a low baseline risk of two percent over sixty percent of people would refuse statins even if the medication could reduce their risk to zero.
Incorporating patient preferences into clinical guidelines may help doctors engage in more effective shared decision-making and improve the low adherence rates currently observed in primary heart disease prevention.

Summary

This research evaluated the discrepancy between clinical guidelines for primary prevention and patient preferences regarding statin therapy in the United States and Japan. Using the smallest worthwhile difference (SWD) metric, investigators surveyed 551 adults aged 40 to 75 to determine the minimum absolute risk reduction (ARR) required to justify daily medication. While current guidelines recommend statins at a 10-year atherosclerotic cardiovascular disease (ASCVD) risk of 7.5% or higher, the study revealed that a significant portion of eligible patients expect a benefit magnitude far exceeding the approximately 25% relative risk reduction typically observed in clinical trials.

The data indicated that at a moderate 10-year baseline risk of 10%, 42.9% of US and 42.4% of Japanese participants declined therapy even after being informed of the drug’s actual efficacy and safety profile. At a low 2% baseline risk, refusal rates reached 75.6% and 62.3% respectively. Most participants required an ARR of at least 7.5 percentage points—representing a 50% to 75% reduction in risk—to consider treatment worthwhile. This high threshold for perceived benefit suggests that expert-led recommendations may not align with the values of the target population, potentially contributing to the low rates of long-term statin adherence seen in clinical practice.

These findings suggest that incorporating patient-centered metrics like the SWD into future ASCVD guidelines could improve shared decision-making. As baseline risk increased to 20%, the proportion of participants refusing therapy dropped to 23.6% in the US, indicating that patients are more willing to accept smaller relative benefits when their absolute risk is higher. By quantifying these preferences, clinicians can better address the gap between medical necessity and patient desire. Ultimately, bridging this interpretative divide is essential for optimizing the primary prevention of heart disease and stroke across different healthcare systems and cultural contexts.

Link to the article: https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2844660

References

Luo, Y., Kawakami, H., Funada, S., Ozawa, S., Sahker, E., Omae, K., Yamamoto, K., Yamaguchi, O., Tajika, A., & Furukawa, T. A. (2026). Measuring public preferences for statin therapy using the smallest worthwhile difference. JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2025.7958