Another guideline problem – inaccurate CV risk estimation

This article – Recent Update to the US Cholesterol Treatment Guidelines summarizes the guideline.  The guideline uses a risk calculator to guide lipid lowering (mostly statin) prescribing. Many critics (including me) felt that the calculator greatly overestimated CV risk.  Since the guideline depends on accurate estimation of that risk, testing and potentially improving the calculator has a high priority. A recent Annals of Internal Medicine article – Clinical Implications of Revised Pooled Cohort Equations for Estimating Atherosclerotic Cardiovascular Disease Risk – tests the original calculator against current cohort data, and then describes 2 new calculators.  The article, very statistically technical, shows a marked improvement in these estimates. Is this a big deal?  Let’s use my data as an example.  I am 69 years old, have a BP of 124/78, total cholesterol 187 and HDL 75.  I have never smoked, and do not have diabetes mellitus.  Using the guideline endorsed calculator, my 10 year CV risk is 12.9%.  The calculator has this suggestion: On the basis of your age and calculated risk for heart disease or stroke over 7.5%, the ACC/AHA guidelines suggest you should be on a moderate to high intensity statin. The newer, better validated and calibrated, calculator estimates my risk at 7.2%.  This is a huge difference!  With this calculator I do not meet the very aggressive guideline that would suggest that I take a statin. From the Annals article...
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs