Moneyball, Gambling, and the New Cholesterol Guidelines
“Lies, damn lies and statistics.” The old adage is emblematic of people’s distrust of statistics, yet in recent years advanced statistics have proven useful over traditional approaches in areas as varied as Nate Silver’s work in political polling and advanced statistics in sports. In November 2013, new cholesterol guidelines, initially developed by an expert National Institutes of Health panel and then endorsed and published jointly by the American College of Cardiology and the American Heart Association (ACC/AHA), took a few steps toward applying more advanced statistical techniques to medical practice.1
The fundamental change is that the ACC/AHA cholesterol guidelines base their recommendations on the best available information on an individual patient’s chance of benefitting from treatment. To achieve this, they noted that we need to stop focusing so much on low-density lipoprotein (LDL) cholesterol levels and focus more on our patient’s overall risk of having a heart attack or stroke. For primary prevention, the new guidelines propose that a statin be recommended once a person’s 10-year risk of having a heart attack or stroke is >7.5%, using a cardiovascular risk calculator developed by the original National Institutes of Health expert panel. Noting that multiple clinical trials have failed to find a significant benefit from adding a second lipid-lowering medicine to a statin, the ACC/AHA cholesterol guidelines generally recommend no additional cholesterol medications for those who tolerate a statin, even if LDL remains elevated.
These guidelines have triggered a cacophony of controversy, with some cholesterol specialists suggesting that the new guidelines will lead to serious undertreatment of high cholesterol and lost lives, and others suggesting that they will lead to overtreatment of millions of Americans.2,3 The net result—utter confusion.
Controversies in medicine have become a dime a dozen, but this medical controversy has a unique aspect to …