New heart risk calculator flawed?

This week, the American Heart Association and American College of Cardiology released new guidelines for who might need to take cholesterol-lowering medications called statins. But this hasn’t come without controversy.

Shortly after the new guidelines were released, some physicians called into question the accuracy of the risk calculator, arguing that its flaws may cause a greater number of patients to unnecessarily receive cholesterol-lowering statins because the calculator relies on old data.

The risk assessment calculator included in the guidelines gauges a patient’s chance of developing atherosclerotic cardiovascular disease (ASCVD) over the next 10 years. ASCVD includes arteriosclerotic heart disease (heart attack, stroke, the chest pain known as angina, or severely narrowed coronary arteries), peripheral artery disease, and stroke or transient ischemic attack. The assessment tool takes into account nine factors, including sex, age, race, total cholesterol, HDL cholesterol, systolic blood pressure, current treatment for high blood pressure, diagnosis of diabetes, smoking habit. The new guidelines recommend a statin for seemingly healthy people with a risk of 7.5% or higher.

“We found that it overestimated risk by a substantial amount,” said Dr. Paul Ridker, according to NPR. “On average, it was between 75 and 150 percent—so a rough doubling. And that’s a substantial overestimation.

This kind of an overestimation could mean that many otherwise healthy people would take a statin long-term with no health benefit, but could be facing the possibility of experiencing harmful side effects.

“These medications can have side effects in people who don’t necessarily need them,” says Dr. Robert Kummerer, a cardiothoracic surgeon with Advocate Condell Medical Center in Libertyville, Ill. “Statins can cause liver or muscle problems.”

Dr. Kummerer adds, “The purpose of the calculator is truly to help primary care physicians identify patients who are at greater risk. So the risk score doesn’t necessarily mean that a patient should be prescribed a statin. Rather, it should prompt a primary care physician to have a conversation with their at-risk patients and help to come up with ways to modify their risk factors. Maybe diet and exercise are appropriate for some patients.”