We've Apparently Been Miscalculating Heart Disease Risk For A While Now. Stephanie Kossman - Medical Daily - Tuesday, 3 May, 2016

For years, doctors have been using a mathematical equation to assess patients’ risk of experiencing a cardiovascular disease event. Called the Atherosclerotic Cardiovascular Risk Equation, the formula assesses an individual’s risk for events such as a heart attack, ischemic stroke, or death from coronary artery disease. Though the equation has been considered a monumental step toward preventing heart disease, a recent study suggests the equation is flawed and has consequently led many patients to be prescribed unnecessary medications.

Published in the Journal of the American College of Cardiology, the study states that the risk equation substantially overestimates adults’ actual risk for a condition called atherosclerosis. Also known as atherosclerotic cardiovascular disease, atherosclerosis occurs when cholesterol plaque builds on the walls of the arteries. Eventually, the plaque can obstruct blood flow, triggering a heart attack or stroke and killing the person.

The risk equation gained popularity as a method of predicting atherosclerosis after it was published by the American College of Cardiology in 2013. However, it was wildly outdated. First developed in the 1990s, the risk equation was based on a group of volunteers with little ethnic diversity and a small age range, making the equation extremely inaccurate when used across different groups of people.

"Our study provides critical evidence to support recalibration of the risk equation in real world populations, especially given the individual and public health implications of the widespread application of this risk calculator," said senior author Dr. Alan S. Go, chief of cardiovascular and metabolic conditions research at the Kaiser Permanente Northern California Division of Research, in a press release.

To determine whether the risk equation could be improved by incorporating data from different ethnic and age groups, the researchers studied the cholesterol levels of a large, multi-ethnic population for five years. Over 300,000 men and women between the ages of 40 and 75 were included in the study.

The researchers found the actual incidence of atherosclerotic cardiovascular disease events in these participants was substantially lower than their predicted risk from the Atherosclerotic Cardiovascular Risk Equation. For groups with a predicted risk equal to or greater than five percent, the actual incidence was 1.85 percent. For predicted risk less than 5 percent, 3.75 percent, and 2.5 percent, the actual incidences were 0.9 percent, 0.65 percent, and 0.2 percent, respectively.

"From a relative standpoint, the overestimation is approximately five to six-fold," Go said. "Translating this, it would mean that we would be overtreating a good many people based on the risk calculator."

For patients who the equation suggests have the highest risk of developing atherosclerosis, doctors prescribe statins, a class of drugs that maintain the body’s cholesterol levels. Though statins have proved to be quite effective in preventing heart disease, the drugs have a lot of side effects, and it is best not to take them if they are unnecessary.

"Statin therapy is a mainstay treatment for millions of Americans," said lead author Dr. Jamal S. Rana, a cardiologist at Kaiser Permanente Oakland Medical Center and an adjunct investigator with the Division of Research.                                                                                                            Source: Rana JS, Go AS, et al. Accuracy of the Atherosclerotic Cardiovascular Risk Equation in a Large Contemporary Multiethnic Population. Journal of the American College of Cardiology. 2016.

21 Replies

  • Equations are developed for the Drug Industry's top- and bottom-line.

  • Now even rosuvastatin gone off patents

    So can expect more focus on PCSK9 inhibitors.. 

  • 10 times as expensive than patented statins right? Brace yourself up for a series of rigged research on how horrible the outgoing statins are.

  • Very true anupjee.....

    We are reading all bad reports about statins after this patent period is over.

  • I never trust what comes from "AUTHORITY" I always look for independent opinions on different websites. And, going by over half a decade of experience and medical reports, I am confident that I am RIGHT.

    My brother has cholesterol 200+ since 2011.

    He was advised Statins. We refused. He is still doing fine without Statins.

    I was advised Omnacortil (steroid). I refused and started Alpha Lipoc Acid which controlled in one month what the doctor could not control in 9 months of trials with all cheap-and-expensive anti histamine drugs. On my final visit, when I tried discussing about ALA he just have a cold response. Told him I did not take STEROIDS.

  • hmm.....I am already on half dose for my BP medicine...and still BP is in normal range.....

    May be in next visit doc may stop BP medicine completely...

    This is due to low carbs >>>>>to weight reduction>>>>reduction of visceral fats...

  • BP -- Another reason lowering of residual insulin in blood. Isn't insulin a vasoconstrictor also?

  • I guess one of the reasons why low carb diets lower BP is because they lower the sodium levels in the body. BTW, do you restrict salt intake?

    How long did you take to normalize your BP on LCHF? And to reverse fatty liver?

  • (1) Normalization of elevated SGPT -  I went for tests 10 months after being Dx'd. No recommendations from the doc.

    (2) Well we may lose Na initially when we lose water due to storing lower glycogen. Don't recall exactly, but Na levels in reports done in 2013 were around the upper end of the range but BP were normal.

    Perhaps someone can answer if TG has relation with BP :)

  • You also got ultra sound scan done for liver to confirm the reversal of fatty liver, didn't you?

  • Nope, never needed it.

    In fact, Nov 2011 and Sept 2013 LFT reports very stable and normal.

  • Low sodium intake has negligible  or no effect on BP.


  • Political Science Of Salt:


  • And yet the only dietary advice that doctors and dietitians have for hypertension is to reduce salt intake by eating less of papad, chutneys, pickles etc.

  • jingale 

    They parrot what they have been told. No mind applied. No one even knows anything about fasting insulin I guess.

  • Hello Anupjee:

    We all now follow LCHF to get BS in control.

    I am following that too, as much as I can with sincerity.

    I am looking for methods similar LCHF to  control high TG (and TC) other than exercise please. 

    I do some walking of course, not much due to the cold weather now. 

    I was prescribed Statin due to the reason that my TG was214 and TC crossed 200.  

    Another pill added was ENLAPERIL 2.5 Mg.

    I am very reluctant to take Statins, but my wife said 

    'Try for some time till it gets in control - probably for a month - and then stop'

    With reluctancy, I started trying this experiment for a while.

    Also, I started on Fish oil to supplement (which has OMEGA3).

    The problem is I feel the irritation in the eyes ( I feel the system goes dry with burning feeling). Would this be because of Fishoil capsules or Enlaperil ?

    Any suggestions pls, if you can

    I understand this is not a forum to ask questions about Allopathic medications. 

    There are several good friends in this forum to provide help / advice. Hence I am approaching.

    Unfortunately, I am in a location where no Ayurveda or other form of medications (not much)

    Even to get my LIPIDs done, I have to go to Allopathy doctors for prescription done to go to Lab - hope you understand)

    Thanks very much.

  • TG-- Cut the carbs. No middle path. Either it's LCHF or it is not LCHF.

  • I have anyway stopped taking atorvas s station since 2 months.... and feel better. I used to also frequently get Virtigo attacks, but it's now 70 days...with no attack at all....uummm it could have been the station !!

  • Good you stopped statins. One of the most over prescribed drug which benefits maybe 1 in 1000.

  • He is talking for his animal 's hearts,and not of humans.

  • For those who know him, he dumped his Statins and diabetes Drug (and even got refund from pharmacy for unused drugs that he returned) after switching to LCHF diet.