Risk Calculator for Cholesterol Appears Flawed | Hacker News Reader

Risk Calculator for Cholesterol Appears Flawed

nytimes.com

27 pointsuladzislau13 comments

"But, in a major embarrassment to the health groups, the calculator appears to greatly overestimate risk, so much so that it could mistakenly suggest that millions more people are candidates for statin drugs."

What? In the Mecca of over-medication & healthcare lobbying, a health group is recommending putting millions of healthy people on lifelong medication?

I'm shocked!!

Statin drugs are nearly entirely generic now, with a 3-month supply being $12, made by competing manufacturers. [1] This is not a profit source for big pharma like you might think.

Statin drugs have fewer side-effects than OTC painkillers. (Heard this on NPR the other day).

1 - http://www.consumerreports.org/health/best-buy-drugs/statins...

33 million new americans on the drug[1], $12 every three months, that's about $1.5 billion dollars a year of new business, by just issuing a new "guideline". In just one country. Not a profit source? I don't agree. Edited to add reference to the 33 million new users. [1] http://www.washingtonpost.com/national/health-science/new-gu...

1) Statins save lives.

2) The people making the recommendations are not the people making money off of the drugs.

3) $1.5 billion is a minuscule slice of the US healthcare market.

4) At $0.13 per pill, it's kind of hard imagining a non-subsidized price getting much lower. What could be done to assuage your concerns?

1) We could go into a rabbit hole with this, I'm not going to, just will remark that there are plenty of credible (subjective I know) who believe statins at best replace one malady with another, they do lower cholesterol while not caring why it's high in the first place. They help people who have already have had a cardiac event, and up to 50 years old. Not older men, and in no case women. 2) No conflicts of interest? 3) I made no claim about slice size, it's still $1.5 Billion per year for one country, and that's not insignificant. 4) so, each pill is cheap.

> Statin drugs have fewer side-effects than OTC painkillers. (Heard this on NPR the other day).

This is actually true for a lot of drug classes. Tylenol (acetaminophen) has such a low injurious dose that it'd probably have difficulty getting approved today.

as someone who has high cholesterol and at the same time gets side effects from statins (body attacks itself via lichen planus when on statins for several months) it sucks to hear this.

The question still remains: how many people really need to be on statins? I have genetically high cholesterol. My mother, and her father, are both on cholesterol meds. But I don't want to be on any medication I don't need, to the point that I (perhaps irrationally) fear being on statins. So, I've tried other things. Diet doesn't seem to make too much of a difference (although one summer where I drank vast quantities of fruit juice seemed to help, but then you run the risk of diabetes), but exercise does, and that I can do. Only thing is, bodies adapt, and now I have to watch out for sports injuries, as I can only seem to get my cholesterol down to mid-170s by hitting a BPM of 160+ for a bare minimum of 30 minutes every day. Much less than every day, and my cholesterol starts creeping up towards 200+ again . . .

I don't mind the exercise - it's good for many things. But if I damage something, to the point where I'm not exercising for months (or even just weeks), should I be put on statins? Based on this article, I would refuse to be put on statins.

From a cardiovascular risk-minimization standpoint, many people should be on statins. From a pure preference standpoint (e.g., I prefer not to take pills, I prefer not to spend $4/month on pharmaceuticals, etc), many of those people will choose not to be on statins.

Their health will probabilistically be worse for this decision; however, health is but one of many competing Goods that people might choose to maximize.

Coincidentally, I recently came across this contrarian view of statins which says that they aren't really all that benign as we think: http://www.zoeharcombe.com/2013/10/how-statin-drugs-really-l...

I haven't read the book, nor can I vouch for the arguments. But take it FWIW.

These calculators aren't just pulled from thin air, they use studies of various populations over time to derive a mathematical model that predicts the cardiovascular risk of a patient. The article is pretty muddled but it appears that two authors of a commentary in the Lancet are arguing with which studies were included in making the models. The big problem is that the commentary hasn't been published yet so there's no way to evaluate whether their criticisms are valid or not. So long story short, this is a crummy summary of an article that we're not able to read yet so not really worth your time.

The co-author of the study (Ridker) and the Brigham have already issued a Press Release disputing the reporter's spin.

Ridker portrays the calculator issues as minor, and offers strong support for statins in risk reduction (which is what the data /strongly/ support):

http://www.brighamandwomens.org/about_bwh/publicaffairs/news...

> Paul Ridker, MD, a cardiologist at Brigham and Women's Hospital (BWH) in Boston, strongly supports the key messages of the new guidelines and believes that questions raised about the risk calculator should be relatively easy to address. Dr. Ridker is an advocate of expanded statin use in primary prevention, a major advance of the new ACC/AHA guidelines.

Good link. Basically we have the person who is cited in the linked article (Dr. Ridker) on record as supporting the new guidelines and finding the errors in the model easy to address. This is an important counterpoint to the sensationalist NYT article from the very person whom they are citing to further their stance.

At MGH, we have already had two noon conferences on the topic. The only disagreement that I've heard with regard to the new guidelines is from those who believe that, on top of the guidelines, there should still be LDL targets for more people, and the targets should be lower than they ever have been before.

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