In a recent study from Stanford University, researchers find that more than 11 million Americans may have incorrect prescriptions for aspirin, statins and blood pressure medications.
The finding is based on an updated set of calculations (pooled cohort equations, or PCEs). The calculations are used to determine the risk of a heart attack or stroke.
In the U.S., the PCEs are the foundation for cardiovascular-disease-prevention guidelines.
They estimate the risk a patient may have for a heart attack or stroke.
In that way, they can help doctors decide whether to prescribe aspirin, blood pressure or statin medications, or some combination of these.
Most physicians calculate a patient’s risk using a PCE web calculator or a smartphone app.
The equations are also built into many electronic health records so that a patient’s risk is automatically calculated during an office visit.
However, the PCEs could be based on outdated data and therefore putting some patients at risk for over- or under-medication.
For example, the researchers found that one of the main data sets used to derive the original equations had information from people who were 30-62 years old in 1948, and who would, therefore, be 100 to 132 years old in 2018 — that is, likely dead.
The older equations were often estimating people’s risk as too high, possibly by an average of 20% across risk groups.
Furthermore, the team found that the old data may not have had a sufficient sample of African-Americans.
For many African-Americans, physicians may have been estimating the risks of heart attacks or strokes as too low.
The researchers have updated the PCEs with newer data in an effort to substantially improve the accuracy of the cardiovascular risk estimates.
The National Institutes of Health, which maintains and updates the cohort data, approved the updated equations.
A second improvement to the equations, the authors found, was to update the statistical methods used to derive the equations.
The work is an example of Stanford Medicine’s focus on precision health, the goal of which is to anticipate and prevent disease in the healthy and precisely diagnose and treat disease in the ill.
The researchers suggest that there is a lot has changed in terms of diets, environments and medical treatment since the 1940s.
“So, relying on our grandparents’ data to make our treatment choices is probably not the best idea.”
By revising the PCEs with new data and statistical methods, the team could substantially improve the accuracy of cardiovascular disease risk estimates.
The study is published in the Annals of Internal Medicine.
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