Ever since new guidelines to identify who needs a statin were introduced in 2013, there have been skeptics. One major suspicion was that the cardiovascular risk calculator used to determine statin eligibility widely overestimated heart disease risk.
That could result in many people—potentially millions—taking these drugs when they shouldn’t. But those concerns were theoretical, based on competing estimates of risk.
Now we have evidence from the first major study that actually looked at what happens with real patients.
The skeptics were right.
REAL PEOPLE’S HEARTS ARE SO MUCH HEALTHIER THAN WE THOUGHT
In this study, researchers put the risk calculator to the test by applying it to the population it was designed for—that is, men and women, ages 40 to 75, who did not already have diagnosed diabetes or cardiovascular disease, with an LDL cholesterol under 190 mg/dL. (If your LDL is above 190, current guidelines recommend a statin even if your risk is low.) Using a large database from Kaiser Permanente Northern California, they identified more than 300,000 men and women who in 2008 fit the profile of the ideal user of the calculator.
According to the cardiovascular risk calculator, the number of these patients who, over the next five years, would have a heart attack or an ischemic stroke (the most common kind) or die from heart disease should have been 10,150 people.
In reality, it was 2,061.
That’s good news of course. But it means that cardiovascular disease was overestimated across the board—at every level of risk. It was found among both men and women and also among major ethnic groups including non-Hispanic white, non-Hispanic black, Asian-Pacific Islander and Hispanic people.
Not everyone in the study would have been a candidate for a statin—but about 30% were. And, based on this study, it appears that four out of five of them who would be candidates for statins based on the standard risk calculator don’t need them.
How could the tests be so wrong? One possibility—the data from which the testing tool was created is based on studies from the 1990s, when more people smoked and developed cardiovascular disease at younger ages.
BETTER WAYS TO FIND OUT IF YOU NEED A STATIN
Here are a few approaches that may be more reliable:
- Use a better risk calculator. According to the Centers for Disease Control and Prevention, the Framingham score is an accurate predictor of cardiovascular risk when measured against actual patient outcomes.
- If your doctor suggests a statin, you may want to discuss getting a coronary artery calcium scan. It detects actual calcium deposits in your coronary arteries, which can predict heart disease before symptoms develop. There is some exposure to radiation involved.
- For women only: Have you had a digital mammogram? You can skip the calcium scan. Instead, ask your radiologist about calcium that may have been seen in the arteries of your breasts, which correlates well with the coronary artery calcium score.
To learn more, see Bottom Line’s “The Big Statin Question.”