Tool estimates risk of heart disease

Dear Dr. Roach: Asa 73-year-old woman, I had a coronary calcium scan done when my new primary care physician wanted to start me on a statin. He discouraged me from having the scan done, saying it wouldn’t change his recommendation. I had tried three statins when I was in my 50s, and all of them caused muscle pain. My coronary calcium scan showed a score of 128. My total of 128 is in the range of 100-400, and put me in the 60th percentile and at “moderate to near future probability for a myocardial infarction.” Please explain how it’s possible that someone with a score of 128 can be in the same risk category as someone with a score of 399.

V.V.

Answer: There are many calculators to give an estimate of risk for developing a heart attack or dying of heart disease, but none of the calculators are perfect.

The MESA calculator (www.mesa-nhlbi.org /MESACHDRisk/Mesa RiskScore/RiskScore .aspx) takes into account a person’s coronary calcium score, as well as other risk factors such as cholesterol, blood pressure and family history.

With the information you gave me, the calculator estimates your risk of a bad outcome in the next 10 years is 12.1%. A statin would be expected to reduce your 10-year risk from 12.1% to roughly 9.7%. Unfortunately, you have had bad reactions to statins, and the decision to try a different one is up to you. There is a benefit, but it is not huge.

Sometimes the muscle aches attributed to statins are not due to statins. In one very powerful trial, people who reported muscle aches to statins were treated for a year: six months with a placebo and six months on a statin. Neither they nor their doctors knew what they were taking in any given month, and the pill they were given changed several times during the year. Every day, they marked down how much muscle pain they had. At the end of the year, the code was broken, and most people didn’t have worsened muscle aches during the times they were taking statins compared to the times they were taking the placebo.