Incorrect Aspirin, Statin, And BP Meds Doses Prescribed?1 year ago
Posted on Jun 10, 2018, 1 a.m.
It is estimated that more than 11 million Americans could have incorrect prescriptions for blood pressure medications, statins, and aspirin based on an updated set of PCEs calculations, as published in the Annals of Internal Medicine.
Pooled cohort equations are used to determine risk of stroke or heart attack and are the foundation for cardiovascular disease guidelines in the USA helping physicians decide whether to prescribe blood pressure, aspirin, or statin medications by estimating risks a patient may have for stroke or heart attack. Most physicians calculate risk using PCE web calculator or app as equations are built into many electronic health records making it easier to automatically calculate during an office visit.
There has been debate whether the PCEs are based on outdated data putting patients at risk for either over or under medication. Two major ways to improve the 2013 equations were found by Stanford Medicine; first being the data used to derive the equations could be updated; and the second being to update the statistical methods used to derive the equations.
Main data sets used to derive original equations had information from people who were 30-62 in 1948, and equations were often estimating risk as too high by an average of 20% across risk groups. Much has changed since the 1940s in regards to environments, diet, and medical treatments, relying on that data is probably not the best idea, additionally the older data may not have had a sufficient sampling of all ethnicities. Results of the deficiencies may have given false reassurances to start treatment that may not have been needed.
PCEs have been updated with newer data which was approved by the National Institute of Health which maintains and updates the cohort data. Revision of the PCEs with new data and statistical methods will substantially improve accuracy of cardiovascular disease risk estimates.
Stanford Medicine’s focus on precision health has been highlighted by this study, showing their goal to anticipate and prevent disease in the healthy, and precisely diagnose to treat disease in the ill.
Materials provided by Stanford Medicine.
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Steve Yadlowsky, Rodney A. Hayward, Jeremy B. Sussman, Robyn L. McClelland, Yuan-I Min, Sanjay Basu. Clinical Implications of Revised Pooled Cohort Equations for Estimating Atherosclerotic Cardiovascular Disease Risk. Annals of Internal Medicine, 2018 DOI: 10.7326/M17-3011