What evidence supports statin use in primary prevention?

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The main idea is that the strongest evidence for statins in people without established ASCVD comes from large randomized trials and their meta-analyses, which show real reductions in major cardiovascular events when statins are used in primary prevention. Across these trials, statins consistently reduce the risk of events such as heart attack, stroke, and other major ASCVD outcomes by about a quarter (roughly a 20–25% relative risk reduction), with the exact benefit depending on the population and outcome studied. The benefit grows in individuals with higher baseline risk, meaning those at greater 10-year ASCVD risk derive more absolute risk reduction. While observational data exist, they’re more susceptible to confounding, and the strongest, most consistent evidence comes from randomized trials. So there is clear evidence supporting statin use in appropriately selected patients for primary prevention.