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Risk of heart attack may be overstated, Hopkins study says

Many people may be receiving unnecessary treatments to prevent a heart attack, according to Johns Hopkins researchers.

The researchers found fault with several common “risk calculators” used by clinicians to determine the likelihood of an individual having a heart attack.

They found that four of the five most common calculators, which are used to determine whether to begin a preventive treatment plan, “significantly overestimate” the likelihood of a heart attack, according to a Hopkins news release.

The study, which is being published Tuesday in the Annals of Internal Medicine, raises concerns about the wisdom of basing clinical decisions so heavily on standardized risk assessment systems, according to senior investigator Dr. Michael Blaha, director of clinical research at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease.

“Our results reveal a lack of predictive accuracy in risk calculators and highlight an urgent need to reexamine and fine-tune our existing risk assessment techniques,” Blaha said in a statement.

“The take-home message here is that as important as guidelines are, they are just a blueprint, a starting point for a conversation between patient and physician about the risks and benefits of different treatments or preventive strategies.”

Physicians use these risk assessments — which use factors such as gender, age, smoking history, blood pressure and others — to determine whether a patient should start a daily regimen of aspirin and cholesterol-lowering drugs, or whether it’s safe to just keep an eye on him or her.

But the risk calculators don’t take into account some other factors that are also significant, such as family history of early heart disease and level of physical fitness.

Many patients may start taking medication when it’s not truly necessary because the risk calculator assigned them a misleadingly high score, according to the study. There can be ramifications of this overzealous treatment, the researchers said.

“For example, cholesterol-lowering medicines, while clearly cost-effective in high-risk patients, are less so among low-risk patients,” said lead author Dr. Andrew Paul DeFilippis in a statement. “Therefore, overestimation of risk could lead to more health care spending, less health gain and unnecessary exposure to drug side effects.”

The American Heart Association says that people who face a 7.5 percent risk of having a heart attack within 10 years should be encouraged to begin cholesterol-lowering medication as preventive therapy.

People who score close to that threshold end up in a gray zone, the Hopkins researchers said. For them, the overestimation of risk score is “particularly problematic” because it “can put a person with a relatively low risk profile into the ‘consider treatment’ group,” officials said.

These patients would benefit from further testing, such as CT scans to check for the severity of calcium buildup in major arteries, said Dr. Roger Blumenthal, a co-author of the study, in a statement.

“Such testing should be considered in all patients with marginal risk scores — those in whom the decision to treat with long-term statin and aspirin remains unclear,” Blumenthal said.


About Alissa Gulin

Alissa Gulin covers health care, education and general business at The Daily Record.