The new cholesterol treatment guidelines were unveiled on November 12, 2013 and controversy flared almost immediately.
A duo of doctors are concerned that the new calculator used in one part of the guidelines seriously over-estimates heart disease risk (the calculator delivers a person’s 10-year risk of heart disease: the new guidelines state those with a risk above 7.5% should take a statin). If they are right, the result would be millions of new people taking a statin — who maybe don’t need this drug.
A serious concern, indeed.
Am about to go into a bit of detail about why it might be over-calculating: if you know already/have been following in the news (or don’t care for the details) skip down to BOLD below!
Harvard professors Dr. Paul M. Ridker and Dr. Nancy Cook tested the risk calculator using THREE studies they chose, of thousands of people over the last decade — and found the calculator over-predicted risk by 75-150 percent. One possible reason for the (alleged) over-prediction is that the new guidelines were based on MANY studies (usually a GOOD thing) but in this case, that means that some of these studies included people from more than a decade ago (a time when far more people smoked than currently do, and thus had more heart attacks.)
The AHA’s response?
As reported by the Boston Globe, “the two organizations that published the guidelines — the American Heart Association and the American College of Cardiology — said that while the calculator was not perfect, it was a major step forward, and that patients and doctors should discuss treatment options rather than blindly following a calculator.”
The article goes on to state that according to Dr. Sidney Smith, executive chairman of the guideline committee, “the concerns “merit attention.” But, he continued, “a lot of people put a lot of thought into how can we identify people who can benefit from therapy.” Further, said Smith, a professor of medicine at the University of North Carolina, “What we have come forward with represents the best efforts of people who have been working for five years.”
So, what’s the deal? Should you use the calculator or not?
I vote YES, emphatically!
Of course, I’m not a doctor (and you shouldn’t believe everything you read on the internet)… but here’s let me tell you why I say YES, you should use the calculator.
As stated in my last post, The New Guidelines, the RATIONALE behind these new guidelines makes all the sense in the world. The new guidelines no longer tie statin medication to achieving a particular cholesterol number.
Said differently, the new guidelines recommend statins only for those AT RISK of heart disease. For those who have high cholesterol but low heart disease risk, statins are NOT recommended.
This makes more sense conceptually (to me) than the prior mandate of hitting a certain cholesterol goal number – especially since those ‘goal numbers’ were not, apparently, tied to anything scientific!
To illustrate, I’ll use, um, me. Yes, I totally get that an n=1 is not useful for anything other than as an example, but I’ll make an example nonetheless.
Under the old guidelines, statin medication was possibly warranted for me simply because my cholesterol numbers were near certain figures — even though I eat well, exercise a lot, and don’t have ANY OTHER risk factors. Net, under the old guidelines my doctor actually TALKED to me about taking a statin, even though I’m healthy and don’t have any heart disease risk factors EXCEPT for “high” cholesterol.
I decided no. But it wasn’t necessarily an easy thing to do.
Under the new guidelines?
Shocker – I am nowhere near that 7.5% heart disease risk cutoff.
That’s because the new guidelines take into account the fact that:
- My LDL (bad) cholesterol is far, far lower than 190
- I’m a female (here’s another huge shock – the original guidelines were created using mostly data from white men. Sigh.)
- My blood pressure is low/normal, and I do not take blood pressure medication
- I’m not diabetic
- I do not smoke.
To me, even just reading this list of inputs into the heart disease risk calculator “proves” this is a significantly better way to estimate heart disease risk than the old guidelines, (which put me as at risk simply because “my cholesterol is above 200.”) The new guidelines just make FAR more sense: they endeavor to predict risk, not get to a cholesterol goal.
So download the calculator (and do it soon in case the AHA gets under so much pressure they take it down) – just click the red button that says, “Download CV Risk Calculator” and save it to your desktop. USE IT! (And if the above link doesn’t work, check my RESOURCES page for latest link.)
Yes, OK, there could be a problem with the calculator…
But don’t decide not to use it because of the potential issue. Instead, use it wisely!
If your result is at or near that 7.5%, take that as a clue to talk to your doctor. Don’t blindly decide you need to start a statin with that result — but do talk to your doctor. Maybe he or she will decide to run some further tests (like C-reactive protein, ApoB and LDL-P – read more here) to really understand your risk.
But do download the calculator and get a sense of your 10-year risk.
- It could save your life. You could truly need a statin and not know it.
- Or you could find out you are at/near the 7.5% risk – and if you do, you can decide what to do about it, with your doctor.
- Or you could be like me and find out statins aren’t indicated – even if the calculator is over-estimating risk.
But now, at least, the calculator means your discussion with your doctor will be focused on the right thing – what, truly, is your individual level of heart disease risk. And you can form a plan based on that, rather than a (seemingly somewhat arbitrary) cholesterol goal number.
So even if the calculator is over-estimating, the most likely result will NOT be millions taking statins unnecessarily. The most likely result will be millions ASKING their doctors about their level of heart disease risk. So they can create a plan together.
Which is the point, no?
To read more about the new guidelines – and why using the new online calculator makes sense – I found these articles particularly insightful:
- From Forbes: “Why The New Guidelines Will Endure“
- From Time Magazine: “Should I Take a Statin? What You Need to Know About the New Cholesterol Guidelines“
- From Harvard Health Publications at Harvard Medical School: “Cholesterol Guidelines Update: Controversy over Heart Risk Calculator“
And just a quick reminder: to use the calculator, you need three pieces of info: your total cholesterol, your HDL (good) cholesterol, and your systolic blood pressure (the first number in the blood pressure measurement).
And last but not least, the calculator cannot be used if you already have heart disease or if you currently take statins: if that’s you, best bet is to talk with your doctor about what the new guidelines mean for you.