The AHA has released a new calculator for looking at risk of CAD, ASCVD, Heart failure for both 10 and 30 years in the future, in those with no current known atherosclerosis.
The link to the professional calculator is here.
Thought this might be interesting for some of our optimized folks to put their numbers into!
I’m 56, looks like:
Risk of CVD 3.5% (10yr) 20% (30yr)
Risk of ASCVD 1.9% (10yr) 10.5% (30yr)
Risk of Heart Failure 2.4% (10yr) 14.2% (30yr)
Looks like I might have to pick one of the less common ways to die. A sudden severe heart attack was an appealing option, but looks like it might be unlikely.
The interesting fact is that if you leave all the values the same but say you are taking an antihypertensive medication, the risk jump dramatically. Therefore, I wonder if it is best to take Telmisartan as a preventative measure. I think so, but I think this exposes a flaw in the calculator as it doesn’t assume you are taking medication preventatively.
I think the model makes sense.
Most lipid medications - especially statins seem to have an independent beneficial effect, beyond just the lower of ApoB, to stabilize plaques. So being on one of these, even without having the true criteria for needing to be on one is something many patients opt to do at low dose.
Medicated Hypertension with a good BP result is lower risk than un-medicated; but not having it in the first place is best. So I’d expect if you had a SBP of 160 and plugged that in, but not on medication, would look worse than having a SBP of 120 and being on meds.
Anyway, it is interesting to manipulate if you think about a patient who has a BMI of 32, HbA1C of 6.5, lipids up, BP up … go on a GLP-1 long term, drop to BMI of 23 and all these things go away … remarkable benefit from just one significant intervention.
I think this is a good one to do pre-post intervention, given that we are talking about modification of predicted outcomes longer term as one way to use this tool. I’d expect that it might take 10 years post intervention for the person to actually have the predicted outcome data as there will be residual risk.
Thanks @AnUser However I think I’ll try a low dose statin to see if I can find one that doesn’t give me side effects. Although I am probably statin intolerant to all statins. I’ll try low dose atorvastatin next.
I think that if you are taking hypertension meds but don’t meet criteria for hypertension - probably the fair thing to do, is record your BP without any BP meds, and check no on the meds for BP and put in that blood pressure.
Plugging in the values from the month before I had a heart attack, when I thought I had no CAD:
This individual has an estimated 10-year risk of CVD = 3.9%
This individual has an estimated 10-year risk of ASCVD = 2.5%
This individual has an estimated 10-year risk of Heart Failure = 1.8%
The calculators are based on massive data and they are predictive on a population basis. So a percentage of people who have a 1% risk … have an event in 10 years in that risk group.
If you want to identify if you’re in that 1% then you’ll need to do some more testing, which typically insurance won’t be paying for.
If you want healthcare for the masses - then you look at the % and realize there is a given % in 10 years, based on massive amounts of data … and roll the dice … or decide to get more testing to make sure you aren’t in the group that will develop disease.
The calculator works just fine in the example above … so long as 96.1% of people in that same risk profile avoid having an event over those 10 years.
The only calculators that I trust are the ones produced by insurance actuaries.
Why? Because when it comes to greed and money, American corporations will always discover ways to maximize profits.