New algorithms to determine heart disease medications may be prone to over-prescribing, according to a report by TIME . Heart disease is responsible for about 25% of deaths in America according to the CDC , and there are many reasons to be cautious in our treatment of it. Many medications  and surgeries  run the risk of causing excess stress to the patient and actually inducing the very same problem they were meant to prevent. Unfortunately, instead of treading cautiously, there may be new problems.
The new formula focused less on specific cholesterol targets and instead created an algorithm of the most significant risk factors, each weighted for how much they might contribute to heart issues. The problem, as many doctors quickly pointed out, was that the new formula seemed to loosen the criteria for putting people on medications, especially ones that lower cholesterol. Simply being older, for example, could push a person into higher risk territory that would warrant a statin prescription, even if this person ate a healthy diet, got plenty of exercise and wasn’t overweight or hypertensive. So this raised serious questions about whether everyone who qualified for treatment under the new guidelines actually needed it.
In a new report published in the Journal of the American College of Cardiology, researchers found that the new recommendations, created by the American Heart Association (AHA) and the American College of Cardiology (ACC), overestimates the risk of heart trouble up to five to six times. That means that five to six times as many people may be prescribed drugs like cholesterol-lowering statins who won’t necessarily benefit from them.
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This is terrifying, as statins can cause muscle degenerating conditions which in turn can cause organ failure.
Dr. Alan Go, chief of cardiovascular and metabolic conditions research at Kaiser Permanente Northern California, and Dr. Jamal Rana, a cardiologist at Kaiser Permanente Oakland Medical Center, and their colleagues studied 307,591 men and women enrolled in Kaiser’s health plans. These middle-aged people represented various ethnic groups and did not have a history of diabetes, previous heart problems or use of cholesterol-lowering drugs.
Because they had data from five years of follow-up with these people, Go and his team could compare how well the new risk calculator predicted their risk of blockages in vessels, or atherosclerosis, against the number of heart events these people actually had. The comparison showed that overall, the new risk calculator was overestimating people’s risk of developing heart problems over five years by about five to six times.
What the data shows, says Rana, is that “perhaps we are over-treating people whose risk may actually be lower, and may not need to be treated with statins.”
Dr. Donald Lloyd-Jones, chair of preventive medicine at Northwestern University who contributed to the development of the AHA-ACC risk tool, acknowledges that it’s not perfect, but also finds fault with the Kaiser study. He points out that rather than being representative, the final patient population was relatively healthy; they could not have had a prescription for a statin or a heart event in the past five years. This group is similar to the older, healthy person who might be considered at high risk just because of his age. “They’re trying to answer, ‘Does the risk score work in the real world clinical population?’” he says. “I don’t think they’re left with the real world clinical population.”
Go argues that one size may not fit all when it comes to predicting who may be at highest risk of heart disease, and different algorithms may be needed for different groups of people. In the current study, for example, the existing AHA-ACC calculator was pretty accurate at predicting risk of heart events among people with diabetes, but less so among the group without the disease. Similarly, there may be other formulas, with different weighting for various risk factors like age, cholesterol level and blood pressure for different groups of people. “We applaud the AHA and ACC for pushing this work, but the calculator isn’t representative of the populations we take care of today,” says Go. “These populations are much more diverse, and different in terms of their risk factors for heart disease. We’re making the argument that the calculator needs to be recalibrated so doctors can use the equation with slightly different parameters to identify the group that’s really at high risk.”
While they agree to disagree on how useful the calculator is as it stands, the study authors and Lloyd-Jones do come to consensus on one thing. “It’s such an enormous burden to put millions of people on statins,” says Rana. “We think there is room for improvement in this.”