Less than a week after the publication of updating recommendations from the American College of Cardiology on cholesterol, which dramatically expands the number of Americans who can benefit from statins, the American scientific community is in turmoil. The cause is an overestimation of patients at risk of cardiovascular disease, heart attacks or stroke.
In normal times, drugs of the statin family are prescribed to fight against excess cholesterol and prevent the risk of cardiovascular disease. The debate revolves around the use of statins in people who have no other abnormality than high cholesterol associated with atherosclerosis (a deposit of lipids on the lining of the arteries). Today, the criticism comes from the doctors supposed to immediately apply the new guidelines, as well as the risk calculator which made it possible to identify the number of patients targeted by this treatment, explains the daily Los Angeles Times.
“If you put the data of the hypothetical patients into the calculator, you get results that are not plausible,” says cardiologist Steven Nissen Daily, who urges colleagues to “take a deep breath and change your mind on these new guidelines” before to apply them. “We are not talking about a 20 or 30% error, but rather 75 to 150%” in the assessment of risk in patients, adds Steven Nissen.
Two Harvard Medical School professors, Paul Ridker and Nancy Cook, estimate that between 13 and 16 million of the 33 million middle-aged adults targeted by the new recommendations do not pose enough risks to warrant statin treatment. On the other hand, advocates of the American College of Cardiology guidelines, including lead author Dr. Neil Stone, believe that the calculator should only be used during the first stage of a consultation process. The doctor’s judgment and the patient’s preferences must be taken into account, he explains to the Los Angeles Times.
“We have erred on the side of caution,” he says, in order to identify patients who should see their doctors. “But the basics of the calculator have been discussed repeatedly by different authors.”