Risk calculator is a helpful, but general, tool



October 28, 2019 - 10:00 AM

Dear Dr. Roach: My friends and I are athletic seniors with no health conditions. We take no medications and eat a plant-based diet. When we put our similar (all in range) test scores in the CVD risk calculator, we made an interesting discovery.

Our numbers consistently fell above the 7.5% 10-year risk until we entered in a younger age. For example, my risk at age 72 was 10.8%, but at age 68, it was 6.7%. Do we need meds because we’re old? Granted, the risk of death increases with age, but this calculator is an argument for medication. — T.K.


Answer: Age is an important risk factor for coronary heart disease, but we seldom discuss it, since it can’t be changed. In many large population studies, about half of men and a third of women developed coronary disease by the time they died. While a healthy lifestyle and management of risk factors can dramatically reduce the risk of heart disease compared with those in a standard population, there is no proven way to reduce the risk to zero.

Having a risk does not mean that you need to take medicines. Had you entered in what would happen if you were to take a statin (you can do this at tinyurl.com/ACC-risk-tool), the calculator would have shown a reduction in your absolute risk by roughly 1.5%, which is what was seen in studies of primary prevention.

However, you and your group do not seem like you would be general candidates for the studies. They were designed to show a reduction in heart attack risk in those at much higher risk. Although the calculator is doing its best, it is likely to overestimate your risk because of your plant-based diet and the athletic habits of your group. The data showing that statins save lives in older individuals are limited (which is why the calculator says it is not appropriate over age 79).

A calculator is a helpful place to start, but an experienced doctor is needed to interpret the information and identify the weaknesses of using a calculator like this for people it has not been developed for.

The risk calculator was developed as a joint project between the American Heart Association and the American College of Cardiology (I am not affiliated with either group) and endorsed by eight other expert groups.

While individuals in the pharmaceutical industry have made some catastrophic errors of judgment, medicines, including statins, have prolonged the lives of hundreds of thousands of people. It is certainly true that adopting a plant-based diet and exercising regularly would have even larger benefits than statins, and at a lower cost. I try every day to motivate people to do so, and to adopt other healthy behaviors.