Improved calculations suggest major changes to statin, aspirin, and blood pressure medication prescribing

1. Updated risk calculations suggest that fewer people should be classified within the high-risk category for CVD.

2. Many Americans, especially those of African American descent, may require reduction and alteration to their statin, aspirin, and/or blood pressure medication.

Evidence Rating Level: 2 (Good)

Study Rundown: Cardiovascular disease (CVD) affects many people worldwide. Treatment for such disease is currently based on 10-year risk estimates, which were derived from five cohort studies conducted in 2013 that generated pooled cohort equations. However, recently these studies have become controversial due to reports on poor risk estimation. The authors of this study aimed to improve the clinical accuracy of CVD risk prediction by revising the 2013 PCEs with newer data and statistical methods. Generally, it was observed that this method of revised PCEs could improve the accuracy of CVD risk estimates. This study has several limitations. First, it is possible that the definition of high risk and low risk utilized in this study may still result in overestimations of patients in the high-risk category. Further, the definition of CVD outcome in this study did not incorporate heart failure or coronary revascularization. Finally, these results may necessitate further reproduction in other studies prior to revision of guidelines.

Click to read the study in Annals of Internal Medicine

Relevant Reading: Comparisons of the Framingham and Pooled Cohort Equation Risk Scores for Detecting Subclinical Vascular Disease in Blacks Versus Whites.

In-Depth [prospective cohort]: The authors of this study compared the original PCEs from 2013 with 2 new alternatives. The alternatives included a revision that used the same methods as in 2013 but applied to updated cohort data, as well as a revision that altered the derivation to address some of the statistical methodological concerns raised regarding the 2013 studies. The patient population included in the study reflected that of the patient population from the 2013 studies. It was observed that the previous calculations might have significantly overestimated risk of CVD in patients. For example, in African American adults, the overestimate of risk was especially significant. 33% of this population had extreme risk estimates (< 70% or > 250% those of Caucasian adults with the otherwise-identical risk factor values. On average, it was determined that the 2013 PCEs overestimated risk by 20% across all risk groups.

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