DEAR DR. ROACH: I read your recent column about the MESA calculator. I found the test myself and input my numbers. But I found that I have a higher 10-year risk when I state that I am using a statin; each time I omit the statin risk, however, my score is actually lower. Common sense tells me that the 10-year risk number would be lower while using a statin. Comments? — G.L.D.
ANSWER: Statins do reduce the risk of developing heart disease, but the benefit is mostly for people with the highest risk. You got a paradoxical answer because you didn’t change your cholesterol numbers. If you had put in the cholesterol results you had before starting the statin (telling the calculator you took no statin), and then compared it with the new cholesterol results on the statin (checking off the box that you are now taking it), you would have seen a reduction in your risk.
A person who begins taking a statin and gets favorable cholesterol results doesn’t have the same risk as a person who has had those same good levels for many years without a statin. You would see the same result with blood pressure in many of the calculators.
There remains controversy, but most data suggests that, eventually, with improved cholesterol or blood pressure for years, a person’s risk eventually becomes almost the same as if they had those numbers without treatment. Not every cardiac risk calculator adjusts based on whether you are on treatment, but a few calculators are able to adjust your risk for the amount of time you have been on treatment.
