Vascular Risk Calculators: Essential but Flawed Clinical Tools?
A recent individual participant meta-analysis of statin trials1 has established beyond reasonable doubt that a patient's pre-treatment vascular risk is the most important, easily measureable, determinant of the effectiveness of statins. In this meta-analysis the calculated baseline vascular risk was a much better predictor of absolute treatment benefit than the degree of low density lipoprotein cholesterol (LDL-C) lowering (Figure 1) and the relative benefits of lipid lowering were largely independent of baseline LDL levels. Numerous studies have already demonstrated that a calculated risk is a much better predictor of future vascular events than LDL-C levels alone, or indeed any other single CVD risk factor.2-4 So many patients with average LDL-C levels but high calculated vascular risk will benefit significantly more from statins than patients at low vascular risk but with higher LDL-C levels. A similar individual participant meta-analysis of trials of blood pressure lowering drugs is currently underway and the preliminary findings are consistent with the statin results (Johan Sundstrom, MD PhD, unpublished data, 2013).
- Received April 7, 2013.
- Accepted April 8, 2013.