Sunday, December 27, 2009

In praise of cardiac risk calculators

I've always had annoyingly high cholesterol levels, but I recently hit both age 50 and a new high cholesterol (though also a new high HDL). I figured it was time to bite the Statins.

First, though, I made the rounds of the risk calculators. I stuck with those on US and Canadian government and educational sites. The results varied depending on where the modeling data was taken from, but I generally fell between a 5% and 7% 10 year risk of a cardiac event (Said even is not necessarily fatal, but certainly unpleasant).

Even more significantly the only thing that really shifted my risk was to change gender. Even a fantastic statin effect, such as taking my cholesterol below 190, didn't change my risk much (from 6% to 4%, for a 33% relative risk reduction but a mediocre absolute risk reduction).

Considering that the statins are unlikely to be risk free [1] I decided to wait until my personal risk tops an arbitrary 10% threshold. In the meantime I'll continue to focus on diet and (especially) exercise.

The key lesson here is the value of these dynamic, personalized, risk calculators. They drive home the lessons we were taught in the 90s about the difference between statistical and clinical significance and they are an early and practical application of the principals of "personalized medicine".

Now if we could only apply these basic principles to airplane security planning...

See also:
[1] We have good reason to believe that the published literature has a systematic bias understating the risks of high value medications. We also know these are powerful medications that act on a wide variety of lipid receptors. On the other hand studies of absolute mortality risk in the last decade have been encouraging -- but those studies were done on persons with much higher risks of cardiac disease than mine.
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