Experts defend heart attack risk guidelines


Published: Wednesday, December 4, 2013 at 12:59 p.m.
Last Modified: Wednesday, December 4, 2013 at 12:59 p.m.

Heart experts who wrote new guidelines for preventing heart attacks and strokes are defending a formula that some doctors say overestimates risk for certain groups.

Doctors who drafted the new advice for the American Heart Association and the American College of Cardiology say that any flaws in the formula are small and should not delay the implementation of the guidelines, which expand how many people should consider taking cholesterol-lowering statin drugs like Lipitor and Zocor or their generic forms.

The guidelines, announced a few weeks ago, are a sea change in heart care. Instead of having people aim for a specific cholesterol number as has been done for decades, the new advice relies on a formula using factors such as age and high blood pressure to estimate a patient's risk.

Under the new advice, one-third of U.S. adults ages 40 to 75 would meet the threshold to consider taking a statin. Under the current guidelines, statins are recommended for only about 15 percent of this group.

Dr. Paul Ridker and Dr. Nancy Cook of Brigham and Women's Hospital in Boston describe in an opinion piece in the British journal Lancet how they tried the formula on patients in three large, observational clinical trials and found it was way off for the number of heart attacks and strokes those patients actually had.

"The predicted risk is roughly twice as high as the observed risk," Ridker said.

However, doctors involved in the guidelines said one reason there were so few of those health problems is that the patients in those studies were prescribed statins to lower their risk. And the groups in the studies Ridker cited were much healthier than Americans in general.

Dr. Sidney C. Smith Jr., a former Heart Association president from the University of North Carolina at Chapel Hill, said dozens of heart experts spent nearly five years carefully reviewing top-quality studies to develop the guidelines and the formula and let other major medical groups review it before adopting it.

"We think that we've come up with a good risk instrument" and intend to move forward to implement the guidelines, he said.

Even Ridker calls the guidelines a big improvement and says the risk formula problems should be easy to address. The guidelines are the first that aim to prevent strokes and heart attacks and customize risk assessment for women versus men.

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