Accuracy of the Atherosclerotic Cardiovascular Risk Equation in a Large Contemporary, Multiethnic Population

J Am Coll Cardiol. 2016;67(18):2118­2130. doi:10.1016/j.jacc.2016.02.055

This is a long and detailed article that requires serious time to digest. The topic is a critical one – who will benefit from Statin therapy. I include the conclusion of the article, and I suggest that anyone prescribing statins take the time to consider the data, interpretation and conclusions of this paper.

We conducted a critical evaluation of the ASCVD Pooled Cohort Risk Equation from a relevant large, diverse, real-world target population, overall & in key understudied subgroups. We found that this risk equation substantially overestimated actual ASCVD risk in adults not treated with statin therapy for primary prevention without diabetes (overall and across all sociodemographic subgroups), and demonstrated suboptimal accuracy in those with or without diabetes. Our study provides evidence to support recalibration of the ASCVD Pooled Cohort Risk Equation in adults without diabetes, especially given the individual & public health implications of widespread application of this risk calculator. Ongoing research & dialogue in this area remains crucial & should be encouraged to provide more rigorous, valid evidence in contemporary, diverse populations.

JLMBIOCITY-BRIEF-Cardiovascular Risk Prediction JLMBIOCITY-BRIEF-Cardiovascular Risk Prediction-Diabetics

Observed 5-year risks of atherosclerotic cardiovascular disease (ASCVD) events within each predicted risk category in eligible adults 40 to 75 years of age shown stratified according to diabetes status.

Personal comment: To put it more simply, the stats for risk from elevated cholesterol were way off. This is by no means a small point. The values for normals of blood results are what establish standards of care. And I am not the only one who suspects that as we collect more and more data and get better at analyzing it, we will discover many such errors.