Most heart “risk calculators” used by doctors overestimate patients' chances of suffering a heart attack, leading to overtreatment, including the overuse of statin drugs, new research shows.
Clinicians commonly use standardized risk assessment systems, or algorithms, to decide whether someone needs daily aspirin, cholesterol-lowering statin drugs, or another heart-disease therapy.
To check the accuracy of each one of five risk calculators, investigators compared the number of predicted versus actual heart attacks and strokes among a group of more than 4,200 people over a decade.
Four out of five risk scores analyzed in the study overestimated risk by anywhere from 37 percent to 154 percent in men and 8 percent to 67 percent in women.
Those that overestimated risk included the one unveiled in 2013 by the American Heart Association and the American College amid controversy about its predictive accuracy.
While the predictions for many people made by such calculators are straightforward, they can be problematic for people who have borderline risk scores that leave them and their clinicians in a gray zone of uncertainty, the researchers said.
“For example, cholesterol-lowering medicines, while clearly cost-effective in high-risk patients, are less so among low-risk patients. Therefore, such overestimation of risk could lead to more healthcare spending, less health gain, and unnecessary exposure to drug side effects,” said Andrew Paul DeFilippis, M.D., lead author of the study, which appears in the journal Annals of Internal Medicine.
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