The American College of Cardiology and the American Heart Association recently released a new heart risk calculator to help physicians make the best recommendations for their patients. The new calculator is quite different from previous risk prediction tools because it focuses less on numbers and more on a person's individual risk of developing heart disease or having a stroke. There has been a lot of controversy about the new heart risk calculator, especially regarding the accuracy of the tool.
In November, two physicians from Harvard Medical School challenged the accuracy of the heart risk calculator, saying it would cause more people to take statins unnecessarily. The old guidelines recommended treating patients with statin drugs if their LDL cholesterol levels were above a certain number. The new guidelines recommend statins for people who have already been diagnosed with heart disease; people with very high levels of LDL cholesterol; diabetics between the ages of 40 and 75; and people with a greater than 7.5 percent chance of having a stroke or heart attack, or developing another form of cardiovascular disease, within the next ten years.
Heart disease is still one of the top killers in the United States, so estimating a person's risk of CVD can help you develop an appropriate treatment plan. The new heart risk calculator uses nine different pieces of information to gauge a person's risk for developing cardiovascular disease within a ten-year period. It accounts for the person's heart disease risk factors and asks for information about the patient's age, total cholesterol, race, systolic blood pressure, and HDL cholesterol level. Epidemiologist Nancy Cook and cardiologist Paul Ridker said the heart risk calculator probably overestimates the risk of atherosclerotic heart disease for "many people." Those people might take statin drugs unnecessarily, exposing them to harmful side effects without producing any real benefits.
The risk assessment work group released recommendations to guide medical professionals in using the new guidelines. If a patient does not have existing heart disease and is between twenty and seventy-nine years of age, you should evaluate the patient's heart disease risk factors every four to six years. If a patient does have cardiovascular disease, the work group recommends reviewing the 2011 AHA and ACC Secondary Prevention Guideline as well as the 2013 Adult Prevention Guidelines for managing obesity, reducing blood cholesterol, and making lifestyle changes. Use these guidelines, along with other guidelines from the American Heart Association, to help your patients understand their risk factors and take steps to reduce the risk of stroke, heart attack, and heart disease.
It will be years before we see how much of an impact the new guidelines have on heart disease risk and the use of statin drugs, but controversy among prominent medical professionals could prompt the AHA and ACC work group to revise the recommendations. As with any other set of guidelines, you must use your best judgment and account for each individual's family history and lifestyle when using the new heart risk calculator.
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