“It gave me a really bizarre answer and showed that he was really below risk, and that didn’t make sense to me at all,” Basu said. “The patient joked with me and said, ‘See, I’m fine. I finally caught you.’ He thought he got one over on me.”
Basu’s reanalysis of the available public data found that African-Americans were under-represented in the initial sample of people that was used to create the 2013 guidelines, and that had an impact on the calculated risk. Also, one of the main data sets used to develop these guidelines was based on details from people who would probably be long dead by the time they would get these medicines.
Basu’s team determined that the 2013 guidelines probably overestimate a person’s risk of atherosclerotic cardiovascular disease by about 20%. For African-Americans, the difference was even bigger, and Basu believes that current risk estimates may be especially low. Therefore, a lot of patients may be getting medication they may not need, and others are getting a kind of false reassurance from their doctors.
“It’s inevitable that we are all going to have to update the data that determines risk factor every few years,” Basu said. “That’s because data sets change, and the ability to collect data improves.” For that reason, Basu said, his team has made their statistic codes public so other scientists can validate them and test them on as many groups as possible before applying the new thinking to clinical practice.
“Keep in mind, these are life and death issues,” Nissen said. Heart problems are the No. 1 killer of Americans. “That’s why it is so important to get this right. We really need a new effort, carefully done, to create a tool that is tested and peer-reviewed before it’s rolled out to doctors.”
Lloyd-Jones, who is also chairman of the Department of Preventive Medicine at Northwestern’s Feinberg School of Medicine, said all risk scores have errors and are like a weather forecast.
“Patients shouldn’t make an assumption that you plug in a number and get a risk assessment, and we write a prescription,” he said. Instead, it’s a starting point. “It gets us in the ballpark. If I think a patient may be a high risk, than I talk with them about checking their coronary calcium score. It answers if you have the disease and will help us get your risk right far more often.”
“Risk prediction as science is an evolving process, and there is no question that it will require continuous updating as society evolves and to keep up with contemporary trends and risks,” said DeFilippis, a cardiologist and associate professor of medicine at the University of Louisville. “There is no question, though, that these calculators are better than the eyeball test and certainly outperform the physician just saying ‘I think this person has a 10% risk’ after meeting and looking at them.”
As far as whether you should use statins, Basu said it’s important to have that conversation with your doctor. People over 40 who have at least a 7.5% risk of stroke or heart disease are generally encouraged to take them.
“It’s important to talk about it with your doctor, because there are some people who are at 5[%], and they want to take statins because even at 5[%], they are at a one in 20 risk of a heart attack. Other people say, with their age and with other things they are dealing with, they don’t want to be a walking pharmacy and don’t want to take them,” Basu said. “Doctors should respect that.”
Basu said he sent his new study to the patient who inspired it. They are trying diet and exercise for a few months to see whether that lowers his risk of heart problems.
“Our motivation with this study is to try and help doctors have that conversation,” Basu said. “It should be based on the most accurate amount of information that is tailor-made for you.”
News credit : Cnn