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What’s the best way for doctors and patients to determine risk?
Last week, the nation’s leading heart organizations announced new cholesterol-lowering guidelines. Central to the recommendations is a new online calculator meant to measure the risk of heart attack and stroke, as well as treatment options. Now, that calculator appears to greatly overestimate risk. “So much so,” reports the New York Times, “that it could mistakenly suggest that millions more people are candidates for statin drugs.”
One leading cardiologist, a past president of the American College of Cardiology, called on Sunday for a halt to the implementation of the new guidelines until further evaluation could be done. The calculator’s reliability was called into question by two Harvard Medical School doctors, Dr. Paul M. Ridker and Dr. Nancy Cook.
According to their findings, which will be published Tuesday in The Lancet, the calculator over-predicted risk by 75 to 150 percent, depending on the subjects. For example, a person with a 4 percent risk, might show up as having an 8 percent risk. Since the threshold for treatment is 5 to 7.5 percent, many more patients would likely be advised to seek treatment, including some with no risk factors at all.
The American Heart Association and the American College of Cardiology said the calculator might not be perfect, and that it wasn’t meant to replace the advice of doctors.
But can the new guidelines be trusted? What’s the best way for doctors and patients to determine risk?
Gina Kolata, senior reporter covering health and science for the New York Times and author of five books, the most recent of which is Rethinking Thin: The New Science of Weight Loss and the Myths and Realities of Dieting"
Arthur Caplan, Head, Division of Medical Ethics, NYU Langone Medical Center