Heart Disease Risk Calculators: Do They Work?
Despite limitations, heart disease risk calculators are a good discussion-starter with your doctor about your risk, lifestyle changes to consider, and whether medication would benefit you.
What do heart disease risk calculators really tell you about your chances of developing heart disease?
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The bottom line is that they are not perfect, but they do have value, according to Michael Rocco, MD, medical director of cardiac rehabilitation and stress testing in the Section of Preventive Cardiology at Cleveland Clinic.
“There is an inherent problem with any kind of risk calculator,” Dr. Rocco says, whether it’s the new ASCVD Risk Estimator developed by the American College of Cardiology and the American Heart Association based on their most recent joint guidelines, the older Framingham Coronary Heart Disease Risk Score, or the Reynolds Risk Score.
“All of the calculators are developed based on data from certain populations and then applied to broader populations. So there is always going to be some misrepresentation if you apply it to a different subgroup of patients that aren’t well represented in the original data,” Dr. Rocco says.
The Framingham Coronary Heart Disease Risk Score was based primarily on a Caucasian, suburban population, for example. Many of the calculators tend to overpredict risk when applied to other broader populations.
Still, despite these flaws, if you don’t have a personal history of heart disease or stroke, heart disease risk calculators can help you start a discussion with your physician about the best strategy for reducing your risk based on your family history and current health status.
That discussion might include diet, exercise and other lifestyle changes, as well as whether taking a cholesterol-lowering statin is a good option.
In some cases, your physician might want to include other test results, such as a coronary artery calcification score, to decide whether therapy would be appropriate. Like all medications, statins can have side effects, and though these risks are generally small, they need to be weighed against the benefits of medication on a case by case basis.
In developing the new ASCVD Risk Estimator, the ACC and the AHA attempted to create a more reliable tool by including African Americans in the population and including both stroke and heart disease as the endpoints.
Still, risk scores need discussion with a physician, Dr. Rocco stresses. For example, results showing that your risk is higher than the designated cutoff for instituting statin drugs (a 7.5% risk over 10 years, according to the ASCVD Risk Estimator) don’t automatically mean that you should start taking medication. At the same time, results below the cutoff don’t necessarily mean that medication would not benefit you now.
For example, a young person with an LDL cholesterol level of 165 and a low calculated short-term risk who has a strong family history and a lifetime risk of over 50 percent might well be a candidate for therapy. “It may be helpful to look at other risk markers, such as this person’s C-reactive protein score or even a coronary artery calcification score, to reclassify risk and if those are abnormal, there would be a stronger rationale to treat this patient,” Dr. Rocco says.
“The calculators are not an end-all; they’re a starting point to assess risk and open a discussion about whether therapy is appropriate,” he says.