Medicalisation, risk and the use of statins for primary prevention of cardiovascular disease: a scoping review of the literature

Primary prevention of cardiovascular disease has been a site of medicalisation, as demonstrated by the significant increase in the use of cholesterol-lowering drugs, statins, over the last thirty years. While this is welcomed by many in the medical community, others have criticised the expansion of statin use to low-risk people. In the context of this debate, the aim of this article is to present a broad scoping review of the literature on how preventative health, risk and ‘candidacy’ for statin treatment are perceived and negotiated by clinicians and patients. We examine how evidence and knowledge about cardiovascular risk reduction is produced, interpreted and communicated and how patients’ gender, socio-demographic and cultural differences may impact patterns of statin use. We found that few studies differentiated between the use of statins in those with and those without established cardiovascular disease, despite the fact that the majority of statin users, and women in particular, fall into the primary prevention category. In this context, the process of medicalisation is predicated on healthy individuals being subject to medical surveillance of risk factors, which have acquired the status of disease in their own right. Central to this process has been the heuristic that identifies elevated cholesterol as a medical problem warranting statin treatment, as well as the difficulties encountered by doctors and patients in understanding, interpreting and communicating risk. This individualised construction of risk and disease has largely ignored the supposedly widely recognised social and political determinants of health and illness.