Several years ago, an alternate method for measuring coronary risk was adopted by the National Cholesterol Education Program's adult treatment panel as an outgrowth of the famous Framingham Heart Study. The newer method, which was referred to as a point-based approach, attempted to make it easier to classify patients into risk groups in order to pursue the appropriate treatment.
However, a new study, which is published in the Journal of General Internal Medicine, compares the two approaches and finds the point-based system "misclassifies millions of Americans" and places them in higher risk groups for which different treatments are recommended. In other words, the implication is that a higher risk classification may prompt greater use of such treatments as cholesterol meds.
The findings: Among 39 million eligible adults, the study notes the original Framingham model categorized 71 percent of the subjects as having moderate risk (or less than 10 percent risk of a major coronary event in the next 10 years), 22 percent with moderately high risk (or a 10 percent to 20 percent chance) and 7 percent with high risk (or a greater than 20 percent chance).
But the study says risk estimates between the original and point-based models "often differed substantially." How so? The point-based system classified 15 percent of adults into different risk groups, with 10 percent "misclassified" into higher risk groups and 5 percent into lower risk groups. As a result, 2.1 million adults were placed in higher risk groups. And these differing classifications could alter treatment strategies for 25 percent to 46 percent of those affected, the study concludes (you can read the study here and the appendix here).
This raises an interesting issue: depending upon the classification, a person may or may not be placed on a statin. And which statin would depend upon LDL goals. For instance, Pfizer's Lipitor and AstraZeneca's Crestor are more potent, which means these pills are more likely to be used for people who need to lower their LDL. The study does not indicate the extent to which the point-based system is employed, but using this logic may lead one to conclude that favoring the point-based system would be in the interest of those drugmakers.
This brings us to an interesting point: one of the study authors is Jesse Polansky, a former Pfizer exec who filed a whistleblower lawsuit accusing the drugmaker of illegally scheming to boost Lipitor sales by misrepresenting federal cholesterol guidelines, among other things (back story with the lawsuit). As noted in the study, Polansky charges that Pfizer promoted the use of the point-based system by distributing a "point-based risk calculator" and funding a software program that uses the point-based model. But whether this study will find its way into his litigation remains to be seen. We imagine that Pfizer. which has previously denied the charges, is certain to object.