Some Minnesota physicians eschew new cholesterol guidelines

Some Minnesota physicians returning from the American Heart Association meeting in Dallas say they will stick with old guidelines for determining when to use cholesterol-lowering drugs, or statins, until the validity of a new risk calculator is verified.

The calculator, released Nov. 12 by the Heart Association and the American College of Cardiology, is designed to estimate a patient's risk of having a heart attack or stroke over the next 10 years.

But after testing the calculator, several prominent cardiologists and researchers found that it vastly overestimates the number of patients who need statin therapy.

"I think someone goofed," said Dr. Rob Schwartz, a cardiologist at the Minneapolis Heart Institute at Abbott Northwestern Hospital.

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Schwartz said when he used the calculator to assess his own risk of heart attack and stroke, it showed that he was very close to qualifying for a statin, even though he has almost no risk factors other than age and gender.

"I'm not overweight. I don't smoke. I'm not diabetic. I exercise a ton. I have no family history," said Schwartz, 62. "And yet it still gave me a value that was near the threshold."

Committee members who created the risk calculator have defended it on the grounds that it is just one of many tools for assessing heart attack and stroke risk. But Schwartz wouldn't recommend using the calculator at all.

"It's too controversial right now," he said. "I think it's going to be a significant hit to our credibility as cardiologists. And, I think it will also give some credence to people who say this is just a conspiracy of the drug companies - which it is not."

Physicians at Mayo Clinic in Rochester won't be using the risk calculator either, until the debate over its accuracy is settled.

Dr. Randy Thomas, director of the Cardiovascular Health Clinic at Mayo Clinic, said his team also found inaccuracies in the assessment tool when they plugged in some test cases.

"Right now, until that's clarified, our policy at the Mayo Clinic is that we will continue to use our previous risk calculator tool," Thomas said. "But I think we have to hold judgment somewhat until we know more of the details [of how it was developed]."

Thomas, who knows some of the committee members who crafted the calculator, characterized them as "careful" researchers.

"They're excellent scientists," he said. "But, there does seem to be some kind of a mistep and I'm not sure where that happened."

The debate over the assessment tool is bound to cause confusion for patients and their doctors. Until physicians sort out how best to respond to the controversy, Thomas said cardiac care could be a fragmented experience for patients.

But he hopes the uncertainty won't last long.

"I think if the associations move quickly and clarify this, then I think that will help significantly to minimize any damage," he said.

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