• Cholesterol Risk Calculator Debacle

    From the NYT:

    Last week, the nation’s leading heart organizations released a sweeping new set of guidelines for lowering cholesterol, along with an online calculator meant to help doctors assess risks and treatment options. But, in a major embarrassment to the health groups, the calculator appears to greatly overestimate risk, so much so that it could mistakenly suggest that millions more people are candidates for statin drugs.

    The apparent problem prompted one leading cardiologist, a past president of the American College of Cardiology, to call on Sunday for a halt to the implementation of the new guidelines.

    “It’s stunning,” said the cardiologist, Dr. Steven Nissen, chief of cardiovascular medicine at the Cleveland Clinic. “We need a pause to further evaluate this approach before it is implemented on a widespread basis.”

    To fill you in, last week new guidelines were released to advise people when to be on cholesterol lowering medications. To be honest, I decided not to write on them until I understood them further. I’m a pediatrician, and I don’t prescribe these things every day. I’m glad I refrained, because – according to this piece – the calculator is massively flawed:

    This week, after they saw the guidelines and the calculator, Dr. Ridker and Dr. Cook evaluated it using three large studies that involved thousands of people and continued for at least a decade. They knew the subjects’ characteristics at the start — their ages, whether they smoked, their cholesterol levels, their blood pressures. Then they asked how many had heart attacks or strokes in the next 10 years and how many would the risk calculator predict.

    The answer was that the calculator overpredicted risk by 75 to 150 percent, depending on the population. A man whose risk was 4 percent, for example, might show up as having an 8 percent risk. With a 4 percent risk, he would not warrant treatment — the guidelines that say treatment is advised for those with at least a 7.5 percent risk and that treatment can be considered for those whose risk is 5 percent.

    Go read the whole piece. The defense offered so far by those with authority here is incredibly weak. This kind of stuff will kill the credibility of guidelines. If these mistakes are real, they must be corrected. Get this:

    Dr. Nissen entered the figures for a 60-year-old African-American man with no risk factors — total cholesterol of 150, HDL (the good cholesterol) of 45, systolic blood pressure of 125 — who was not a diabetic or a smoker. He ended up with a 10-year risk of 7.5 percent, meaning he should be taking cholesterol-lowering statins despite being in a seemingly low-risk group.

    Dr. Nissen also calculated the figures for a healthy white man, age 60, and also got a risk factor of 7.5 percent.

    “Something is terribly wrong,” Dr. Nissen said. Using the calculator’s results, he said, “your average healthy Joe gets treated, virtually every African-American man over 65 gets treated.”

    And people wonder if we do too much in the US, when it comes to health care.

    @aaronecarroll

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    • New guidelines might have to be tweaked, but a step in the right direction. Much less dogmatic.

      I’ve always had high total cholesterol, but also high HDL

      Since my LDL was 168 I was urged to go on statins. I lasted a month before I developed nerve damage. I know nerve damage as I’ve had pinched nerves in the past, and two spine surgeries.

      With the new guidelines, the statin pushers will now leave me alone. My 10 year risk is 5.4 percent. Further, my VAP cholesterol test shows I have a very high “untra-good” HDL-2, and my LDL is “pattern a” (low density, less likely to clot).

      Statins can cause damage. I really wish there was more emphasis on looking for signs of risk (like plaque deposits) before pushing the drugs.

    • We should note the large amount of (additional) money to be made when everyone is on statins and the potential of that money to corrupt the process.
      Many of the experts who put this plan together have financial ties to the drug industry.
      Follow the money.