Koo,

I see your point. There is definitely a gray area between primary and secondary prevention for high-risk patients. As you point out, some patients may have many risk factors (diabetes, low HDL, high LDL, inflammation, renal disease, evidence of atherosclerotic plaque, vascular calcification, etc) that put them at high risk for first MACE but may not have yet experienced that first MACE. The main message from that statin study is that many patients without other risk factors aside from elevated LDL-C may not benefit much from statins and the side effects of statin use in low-risk patients may outweigh the small benefit.

BearDownAZ