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My doctor strongly recommended that I start taking a statin late last year after a coronary calcium scan indicated my arteries were housing enough calcified plaque to threaten the ongoing operation of my circulatory system. My total calcium score of 871, according to the cardiologist evaluating the results, put me in “the 81st percentile for matched age and gender.”

I’m not particularly fluent in the diagnostic jargon of cardiologists or the peculiar calculus practitioners employ to persuade people like me to step into the Big Pharma vortex, so I was in no position to debate the verdict. I’ve been dutifully swallowing my daily atorvastatin for the past six months while wondering when the side effects would kick in. They haven’t yet, as far as I can tell, and my total cholesterol count has descended into what I’m told is an acceptable range.

All of which would suggest that following the advice of my healthcare providers — however murky their criteria — was the proper choice. But recent research has raised some eyebrows, including my own, about some of the guidelines practitioners use to prescribe statins.

The results of a study published last week in JAMA Internal Medicine argue that a popular tool currently used to determine heart disease risk has resulted in unnecessary statin prescribing. Indeed, if revised criteria approved last fall by the American Heart Association (AHA) were accepted, about 40 percent fewer people would be prescribed the drug.

“This is an opportunity to refocus our efforts and invest resources in the populations of patients at the highest risk,” notes lead study author Timothy Anderson, MD, a physician and researcher at the University of Pittsburgh Medical Center.

Reviewing data on 3,785 adults (40 to 75 years of age) who participated in the National Health and Nutrition Examination Survey (NHANES), Anderson and his team compared this cohort’s 10-year risk of atherosclerotic cardiovascular disease (ASCVD) when measured by the Pooled Cohort Equations (PCE) calculator, which was approved in 2013, against their risk when calculated with the new Predicting Risk of cardiovascular disease EVENTs (PREVENT) tool.

The results were fairly staggering: The portion of participants showing a risk of developing ASCVD dropped by half — from 8 percent to 4 percent — when measured by the new calculator. (And the difference for those 70 and older was even more pronounced, falling from 22.8 percent at risk to 10.2 percent.) The upshot? About 4.1 million current statin users would not have been prescribed the meds under the new protocol, and the total number of U.S. adults who would qualify for a statin would drop from 45.4 million to 28.3 million.

“We don’t want people to think they were treated incorrectly in the past,” Anderson explains. “They were treated with the best data we had when the PCE was introduced back in 2013. The data have changed.”

When designing their PREVENT tool, AHA scientists analyzed health data on more than 6 million adults from various socioeconomic, geographic, racial, and ethnic backgrounds and, unlike the PCE calculator, the tool they designed incorporated cardiovascular, kidney, and metabolic measurements. Without accounting for such markers as blood-sugar levels (HbA1C) and kidney function (eGFR, uACR), the PCE tool overestimated the participants’ risks.

“We updated the AHA risk prediction model to PREVENT, reflecting the growing influence of inter-related metabolic risk factors (obesity, diabetes, metabolic syndrome) and chronic kidney disease on cardiovascular disease risk,” Chiadi Ndumele, MD, PhD, chair of the AHA’s CKM scientific advisory group, tells STAT News. “It is therefore not surprising that the investigators found about twice the predicted event rate for the PCEs vs. PREVENT.”

Ndumele notes that further analysis will determine when and how physicians will use the new calculator to guide their treatment approaches. Currently, patients with a 7.5 percent or higher risk of heart disease are typically prescribed a statin. At 5 percent or lower, they generally take a wait-and-see attitude. And the risk generally rises as we grow older.

But numbers are only numbers, Anderson acknowledges. Risk estimates, regardless of their origin, should ideally provoke a conversation between physicians and their patients about treatment options — including statin use. “The prior risk equations and the PREVENT equations that we focus on in this study really seek to give doctors and patients sort of a starting percentage to say, ‘Is it worth having a conversation about statins?’”

That’s not exactly what happened in my case. An earlier hypertensive crisis focused attention on my blood pressure and sent me to the pharmacy for an ACE inhibitor and a calcium channel blocker. When my doctor later pointed to my elevated cholesterol count, I was hesitant to commit to a statin regimen, having read plenty of reports alleging its harmful side effects. So, she suggested the coronary calcium scan as a way to assess my arterial condition — and perhaps lower my resistance to the proposed remedy. The numbers were (eventually) persuasive, and the atorvastatin has proved beneficial.

Still, I couldn’t help but plug my numbers into the new PREVENT calculator, just to see whether I was one of those septuagenarians who, upon further review, maybe didn’t need the statin after all. The results suggest that my healthcare team — despite its impenetrable diagnostic process — may know a little bit more about heart disease risk than I do. PREVENT tells me that, in the next 10 years, I have a 15 percent chance of developing cardiovascular disease, an 8.3 percent chance of ASCVD, and a 10.8 percent chance of heart failure.

Not terrible odds, in the grand scheme of things, but I think I’ll keep taking my meds.

Craig Cox
Craig Cox

Craig Cox is an Experience Life deputy editor who explores the joys and challenges of healthy aging.

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