TOPLINE:

Most adults in the US and Japan expected larger reductions in 10-year risk for atherosclerotic cardiovascular disease (ASCVD) than statins offer. At current effectiveness levels, about one third or fewer said they were willing to start statins.

METHODOLOGY:

• Researchers conducted online surveys of adults aged 40-75 years who had never taken statins to assess how much reduction in CV risk would make people feel statins are worth taking.
• They included 254 US adults and 297 Japanese adults (mean ages, 52.7 years and 58.4 years, respectively; 50.8% and 54.2% women, respectively).
• Adults received explanations about the benefits and burdens of statin use, including adverse effects, costs, and inconvenience, and completed short checks for understanding.
• Using step-by-step questions with simple graphics, adults identified the minimum drop in 10-year risk for ASCVD that would make taking statins feel worth it at baseline: low (2%), moderate (10%), and high (20%) risk levels.
• Researchers examined whether adults were willing to take statins at current effectiveness, approximately 25% relative risk reduction per 38.61 mg/dL reduction in low-density lipoprotein cholesterol level.

TAKEAWAY:

• Among adults with low 10-year risk for ASCVD at baseline, 75.6% of US respondents and 62.3% of Japanese respondents declined statins even if risk could be reduced to zero.
• Among those at moderate risk, 42.9% of US adults and 42.4% of Japanese adults declined statins; at high risk, 23.6% in the US and 38.4% in Japan declined statins.
• At moderate risk, adults expected a median risk reduction of 7.5% in both countries, increasing to 10.0% in the US and 12.5% in Japan at high risk.
• In the US, 13.8%, 23.6%, and 34.2% of adults reported they would take statins at their current effectiveness under low, moderate, and high risk, respectively; the corresponding proportions in Japan were 19.2%, 23.9%, and 30.6%.

IN PRACTICE:

“Even for well-established treatments like statins, gaps may exist between public expectations and guideline recommendations. The SWD [smallest worthwhile difference] may help incorporate patient preferences into guidelines and support effective communication frameworks for shared decision-making,” the researchers wrote.

“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,” experts wrote an accompanying editorial.

SOURCE:

The study was led by Yan Luo, MD, PhD, of the University of Tokyo Graduate School of Medicine in Tokyo, Japan. It was published online on February 16, 2026, as a research letter in JAMA Internal Medicine. The editorialists were Ilana B. Richman, MD, MHS; Anna Hung, PharmD, PhD; and Timothy S. Anderson, MD, MAS.

LIMITATIONS:

The study used an online survey, which may have introduced bias. Researchers made simplified assumptions about the effectiveness of statins.

DISCLOSURES:

The study received a grant from Pfizer Health Research Foundation (Japan) and intramural funding from Kyoto University Graduate School of Medicine. One author reported receiving grants from Japan Society for the Promotion of Science and being an employee of the University of Tokyo Hospital. Several other authors reported receiving personal fees, honoraria, and grants and having other financial and nonfinancial ties with multiple pharmaceutical, medical devices, and healthcare companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.