Dr. Kumar’s Take:
Doctors often use a tool called the ASCVD (Atherosclerotic Cardiovascular Disease) Risk Calculator to estimate a person’s chance of having a heart attack or stroke. But this study shows that the calculator may be overestimating that risk—sometimes by a lot—especially for people without diabetes. That means many people may be prescribed statins when they might not need them.
If you’re told to start a statin just based on your risk score, it’s worth discussing the numbers with your doctor and considering other factors like lifestyle, family history, and current health.
Key Takeaways:
✔ The risk calculator overestimated heart disease and stroke risk by 2 to 6 times.
✔ This happened across all racial and ethnic groups, including Asian, Hispanic, Black, and White patients.
✔ The tool performed slightly better in people with diabetes, but was still not very accurate.
✔ This could lead to unnecessary statin prescriptions and possible side effects.
Brief Summary:
A large study of over 307,000 people found that the ACC/AHA Pooled Cohort Risk Equation often overestimated the risk of heart attacks and strokes over 5 years. The study looked at real-world data from a diverse group of patients between 40 and 75 years old, most of whom did not have diabetes. Even in higher-risk categories, the actual number of heart events was much lower than predicted.
Study Design:
Researchers at Kaiser Permanente looked at medical records of over 300,000 adults between 2008 and 2013. They excluded people who already had heart disease, were on statins, or had very high or very low cholesterol. They used the standard ASCVD risk calculator to predict 5-year risk and then checked how many people actually had events like heart attacks or strokes.
They also looked at different groups: men vs. women, different races, income levels, and whether or not the person had diabetes.
Results:
- Only 0.20% of people in the lowest risk category had a heart event in 5 years, even though the calculator predicted up to a 2.5% risk of a heart event.
- In the highest risk category, the predicted risk was ≥5%, but the actual number of heart events was just 1.85%.
- In people with diabetes, the calculator was better at estimating actual risk, but not by much.
- The tool was especially inaccurate for people taking statins for prevention.
Why This Matters:
Doctors use the ASCVD calculator to decide if someone should take statins. But if the tool isn’t accurate, patients could be taking medication they don’t need. This study suggests we should be cautious about relying too much on risk scores alone—especially for those without diabetes and those from diverse backgrounds.
Related Studies and Research
Triglyceride/HDL Ratio and Heart Disease Risk – Investigates how the TG/HDL ratio can serve as a more reliable cardiovascular risk marker.
Statins and Diabetes Risk: A Review – Examines concerns over increased diabetes risk with statin therapy.
Coronary Artery Calcium and Statin Allocation – Reviews how CAC scoring can improve risk prediction beyond traditional tools.
LDL Cholesterol and Heart Disease: A Review – Evaluates the relationship between LDL levels and cardiovascular risk.
Mediterranean vs. Low-Fat Diets for Heart Health – Compares diet-based prevention strategies for cardiovascular disease.
Frequently Asked Questions
What is the ASCVD Risk Calculator?
It’s a tool that estimates your 10-year risk of heart attack or stroke. It uses your age, cholesterol levels, blood pressure, and smoking history to give a percentage.
Why does overestimation matter?
If your risk is overestimated, you might be prescribed a statin you don’t really need. That can mean unnecessary side effects and costs.
Should I stop taking my statin?
No—always talk to your doctor first. But if you were started on a statin based only on your risk score, it might be worth revisiting the decision and discussing your options.
Are there better tools available?
Some newer tools try to include calcium scores or family history. But there’s no perfect model yet. This study suggests more accurate, updated calculators are needed for modern, diverse populations.
Where can I get my risk score checked?
You can check your current risk score using the ASCVD Risk Calculator here.
Conclusion
This study shows that the widely used ASCVD risk equation often overpredicts risk, especially in people without diabetes. It raises important questions about how we decide who should take preventive medications like statins. As always, personalized care and shared decision-making are key.
If you’re being told to take a statin based on your calculated risk, don’t be afraid to ask questions. It’s your health, and it’s worth the conversation.