The ASCVD risk estimator overestimates risk of heart disease by ... a lot

(Bob M) #1

It’s really a bad guess.

It’s fun to play with, though. Just add different ages or cholesterol:!/calculate/estimate/


As well, the time span in these estimators is short—5 to 10 years. I am aware of medical doctors who have a family history of ASCVD and have decided to be proactive. Taking relatively smaller doses of a statin medication such as Pravastatin or Zetia with a PCSK9 inhibitor in the hope of significantly reducing their risk.

What is wrong with being proactive? If you have a family history and specific blood markers and, through consulting with your doctor, can minimize the long-term risk of ASCVD, why would you not attempt to reduce it? Why wait for the symptoms to appear before you start taking the medications? The largest study on statins shows those who suffer from side effects are only between 6 and 10%.

(Bacon is a many-splendoured thing) #3

Well, duh! :rofl:

(Bacon is a many-splendoured thing) #4

The problem is not being proactive, the problem is that lowering cholesterol doesn’t prevent cardiovascular disease. There is plenty of evidence to show that. Several large studies, in fact, including one designed by Ancel Keys himself, showed a negative correlation between LDL level and cardiovascular disease. That alone is solid proof of a lack of causal relationship.

Even if we were to assume that LDL was a marker for cardiovascular disease (and the data show that LDL level is practically useless for that purpose), it is useless to treat a disease by manipulating the marker. Getting rid of the actual cause of the disease (which in this case is hyperinsulinaemia, also known as insulin-resistance) makes much more sense.

So if you were suggesting being proactive by embarking on a well-formulated ketogenic diet, I’d be all for that. I am not in favour of statins, because there’s too little return for the cost of the side effects.

(Bob M) #5

If statins work at all, it’s not by LDL reduction, but by other effects, such as reduction in inflammation. For instance, studies where they compare the actual LDL reduction by taking statins show no relative benefit when LDL is lowered more.

If the AHA actually wants to do something that shows risk, have everyone get a CAC scan and use that. If you go into that calculator and raise TC and LDL, risk goes up…but we know CAC scans don’t correlate with that. In other words, you can have lower cholesterol and have high atherosclerosis as evidenced by CAC, or very high LDL and have low atherosclerosis as evidenced by CAC.

CAC scans actually quantify risk. Markers like LDL do not (as evidenced by the horrible calculations). .

The other issue is that healthy people without heart disease taking drugs (called primary prevention) is problematic, particularly because the main benefit to statins appears to be as secondary prevention (when people have heart disease).

(KM) #6

A little aside: I sat in on my hub’s dr appointment; he started in with statins and when he noticed that my right eyebrow had inadvertently shot up into my hairline, he sadly said, “I know. I know. But we treat these things with medicine, because it’s the only tool we have”. DUDE! What the hell are you doing? Go be something else if this is the only “tool” you have!!!

(Bacon is a many-splendoured thing) #7

“Let food be thy medicine.”–Hippocrates