Healthcare

Statins, aspirin and BP medication, oh my𗀼

Improved calculations suggest major changes to statin, aspirin, and blood pressure medication prescribing

Eleven million Americans, especially African Americans, may need to talk to their doctor about their prescriptions

Abstract: http://annals.org/aim/article/doi/10.7326/M17-3011

Editorial: http://annals.org/aim/article/doi/10.7326/M18-1175

Researchers have developed an improved method for calculating risk for heart attack or stroke that challenges current prescribing methods for statins, aspirin, and blood pressure medications. According to the researchers, 11 million Americans may need to discuss taking different prescriptions with their doctor. For many, these medications are overprescribed, but for African Americans, older risk calculations from 2013 may underestimate their risk. Findings are published in Annals of Internal Medicine.

In 2013, researchers derived Pooled Cohort Equations (PCEs) to help physicians weigh patients’ risk factors and decide whether to prescribe statins, aspirin, or blood pressure medications to prevent heart attack or stroke. While the PCEs were widely accepted, many users questioned whether the outdated data used to create the PCEs may put patients at risk for over- or under-treatment. According to the authors, one of the main datasets used to derive the original equations had information from people who were 30 to 62 years old in 1948, and who would therefore be 100 to 132 years old in 2018 — or likely dead. The old data also underrepresented African Americans and physicians may have been estimating their risks as too low.

A team of researchers lead by Stanford University, created an updated set of calculations using modern cohorts and updated methodologies. Using their new calculations, the researchers found that 2013 PCEs overestimated 10-year risk for atherosclerotic cardiovascular disease by an average of 20 percent across risk groups, but for some Americans, particularly African-Americans, risk estimates were too low. This means that many patients may have been prescribed medications that they do not need, while others may have been given false reassurance.

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