Cholesterol risk calculator is too risky

December 1, 2013 • Editorial

While the health care system might be a fit [auth] topic for newspaper advice, medical care is not.
This was proven yet again when it was widely reported this month that the nation’s leading heart-health organizations had unveiled a “risk calculator” expected to show that tens of millions more people should be taking cholesterol-lowering statin medications.
It’s not as though millions of people aren’t already taking statins. The class of drugs is among the most commonly prescribed. A 2011 study from Harvard Medical School estimated that about 32 million Americans — some 25 percent of the population over age 40 — take them.
The fear-factor calculator was put out by doctors and pharmaceutical companies, among whose goals are to keep raking in more money for Big Pharma. Even skeptical reporters are often not equipped to calculate and counter the information put out by scientists and medical experts. That sort of analysis has to come from other medical professionals.
Which it did, six days after the first reports. Two Harvard physicians challenged the accuracy of the calculator, saying it would cause people to unnecessarily take a statin. Critics asserted that the online calculator was flawed and appeared to greatly overestimate the risk of heart attack or stroke that healthy people could be facing in the next 10 years.
Following those warnings, media outlets quickly backtracked on the earlier stories. Reporters quoted new advice that patients in good cardiovascular health should avoid following the new cholesterol guidelines.
Patients who already have had a heart attack, have diabetes or extremely high levels of “bad cholesterol” (LDL) were advised to remain on prescribed statins or to see a doctor to determine whether they should be on the medication.
The faulty guidelines were issued by two reputable organizations, the American College of Cardiology and the American Heart Association.
How does inaccurate information like this get out to the public?
As Dr. Howard LeWine of Harvard Health Publications, wrote on Tuesday: “It’s been a topsy-turvy few days in the world of heart health and disease.”
The calculator included in the guidelines used nine pieces of information to gauge whether a person was likely to develop atherosderotic cardiovascular disease within a decade. “Atherosderotic” includes peripheral artery disease and stroke or transient ischemic attacks, along with the conditions normally associated with heart disease.
The nine pieces of information were: Sex, age, race, total cholesterol, HDL (good) cholesterol, systolic blood pressure, current treatment for high blood pressure, a diagnosis of diabetes and a smoking habit. Statins were recommended for people who ranked a 7.5 percent risk on the calculator, no matter how healthy they currently may be.
The Harvard doctors argued that the recommendations from the calculator were formulated with unreliable data and that the calculations are off-base.
The debate over the calculator has raised questions about heart health guidelines that advise even greater numbers of people to take statins. It also has brought into question the motive of drug manufacturers who fund medical research.
Dr. LeWine warns that despite the controversy, there still are categories of patients who absolutely benefit from the statins, which can be life-saving medications. He also noted that tests are under way to determine whether genetic testing may help better direct physicians on how to treat patients at risk of cardiovascular disease.
Meanwhile, it’s reassuring that physicians refuted the questionable medical advice. And, while it is undoubtedly confusing for those seeking medical advice online or from news media, it is also a cautionary tale.
The best suggestion for good medical advice is to consult your doctor.

Guest Editorial
The St. Louis Post-Dispatch

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