Doctors Identify Problems With New 'Cholesterol Calculator'

Nov 19, 2013
Originally published on November 18, 2013 3:44 pm

Today’s New York Times reports that two Boston-based cardiologists have spotted flaws in the online calculator for assessing who should be treated with cholesterol-reducing statin drugs. The Times also reports that doctors’ concerns about the calculator were not relayed to the task force writing the guidelines.

The calculator was unveiled last week as part of a new set of guidelines for who should take statins, which would result in twice as many Americans taking the cholesterol-reducing drugs.

Cardiologist Steven Nissen told Here & Now’s Meghna Chakrabarti last week that no calculator is perfect, but he agreed with the new guidelines, which identify people who should take statins based not just on cholesterol levels, but also on risk levels.


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From NPR and WBUR Boston, I'm Robin Young.


I'm Jeremy Hobson. It's HERE AND NOW. Coming up, the Midwest is picking up the pieces after yesterday's swath of deadly tornadoes.

YOUNG: We'll have that story for you. But first, serious questions are being raised today about that new online calculator that doctors have been urged to use to determine risk of heart attacks. You'll remember it was unveiled just last week by the American Heart Association and the American College of Cardiology as part of sweeping new guidelines that would result in twice as many Americans taking cholesterol-reducing statins.

But two Boston researchers spotted problems with the calculator a year ago. They said it over-predicted risk. Others are now saying that could be because the calculator was based on old data. Either way, somehow the criticism fell through the cracks, and now there's concern that people already skeptical that the calculator was all about selling more medications may ignore it.

Dr. Peter Libby is chair of the Department of Cardiovascular Medicine at Brigham and Women's in Boston. He's at the annual meeting of the American Heart Association in Dallas. And Dr. Libby, we understand this criticism has thrown that meeting into some turmoil. What's been the response to the questioning of the calculator?

PETER LIBBY: Well, there have been a lot of corridor conversations, and I think it's very important to recognize a couple of points, first of all, that the new guidelines are an enormous step forward. We have done away with the know your number, and have decided that the data do not really support a particular bad cholesterol, or LDL goal.

And the panel has done a very good job of reevaluating a lot of the evidence, and it's an important step forward.

YOUNG: In other words, instead of just knowing the number of your bad cholesterol, if it's too high, there are other factors that are factored into this calculator to see if you might be at risk. You might have really good-looking cholesterol, but have other things, like family background. And that was the thinking.

But, apparently, it's your fellow cardiologists at Brigham and Women's in Boston - Dr. Paul Ridker and Nancy Cook - who tried the calculator and felt - this was a year ago - and felt that it was reining in far too many people. What seems to be the problem?

LIBBY: The problem is that if the experts are having this kind of controversy, I think we lose sight of a very important public health goal, and that is trying to prevent heart attacks and strokes. My concern is with this confusion and controversy among the experts that the medical public, the practitioners, and the general public will say well, wait a minute, whoa. Maybe the statins are not for me. Let's wait until the experts sort this out.

YOUNG: Right.

LIBBY: So I think it's a very important public health message, that if you have had a heart attack or a stroke or have established coronary artery disease, or if you have diabetes, you really need to have a conversation with your doctor about being on statin drugs because it is very likely that you will be considered a person who could benefit, regardless of whether a calculator calculates your risk at 7.5 percent, 8.5 percent or 6.5 percent.

YOUNG: Some people are saying that maybe the calculator was based on groups of people that were too healthy, so that their - it's reaching people who really shouldn't be on statins. Is there a sense there that the calculator will now be adjusted so that it's more accurate?

LIBBY: Well, I can't speak for the American Heart Association or American College of Cardiology. What I'm really concerned about is that we don't throw out the baby with the bathwater. Let's try to stick to the main message, which is that statins can prevent heart attacks and strokes when they're appropriately deployed, and you don't need to use a risk calculator to do that.

YOUNG: Well, but it would seem that you have some work, doctors have some work to do, because already, there are reporters like NPR's Richard Knox who went through the calculator and were misdirected to statins, when, in fact, his doctor told him, no, you absolutely are not a candidate. So it would seem that there has to - that there, you know, would probably be a fix somewhere down the road.

LIBBY: I think that that's very likely, but I can't speak for the expert panel. And, you know, some of the talk about the - enriching the pharmaceutical industry is irrelevant, because almost all of the statins are generic now, and the cost is much less of an issue than it was several years ago.

So now it's a matter of public health, and we can be guided by the trials.

YOUNG: Dr. Peter Libby, chair of the Department of Cardiovascular Medicine at Brigham and Women's in Boston. Doctor, thank you.

LIBBY: Thank you very much. Transcript provided by NPR, Copyright NPR.