New Heart Attack Risk Calculator Could‍ Limit Access to Treatment

‍⁢ ⁤ ⁣ Updated ⁤june 11, 2025

A newly developed cardiovascular disease risk calculator, designed to better assess⁤ a ‍patient’s risk of heart‍ attack and stroke, may inadvertently reduce access to ⁤crucial medications, according to Harvard Medical ⁤School research published in JAMA. The analysis suggests that under current treatment guidelines, the new calculator could make ⁣nearly 16 million people newly ineligible for ⁤cholesterol and blood pressure therapies.

This shift in eligibility, especially affecting men ages 50 to 69, could lead to ⁢an estimated 107,000 additional heart attacks and strokes over the next decade, the research forecasts. The⁢ study highlights the importance of aligning risk assessment with treatment strategies for cardiovascular disease prevention.

James Diao, ‍a resident physician at Brigham and Women’s Hospital and the study’s first author, emphasized the need to⁤ re-evaluate treatment thresholds considering ‍the updated risk estimation.⁤ Raj Manrai, assistant professor of biomedical informatics ⁣at HMS, echoed this sentiment, stating that changing risk prediction without reconsidering treatment⁢ criteria could alter recommended care ‍for millions.

The PREVENT calculator, unveiled by the American Heart Association in November 2023, incorporates recent data reflecting⁢ population and cardiovascular trend changes. It provides 10-year risk estimates for those ages 30⁢ to 79⁤ and 30-year estimates for those 30 to 59.Unlike its predecessor,⁣ PREVENT excludes race as a factor and includes variables like kidney function, blood sugar, urine protein and neighborhood ⁣zip code. It also recommends starting risk assessment at age 30 instead of 40.

Researchers projected the clinical effects of the new calculator using⁣ data from nearly 7,700 participants in ‍the U.S. National Health Examination ⁣and Nutrition Survey. They found that the new calculator would reclassify nearly half of the U.S.population into lower risk categories, with very few people being reclassified into higher risk categories.

The analysis indicated that⁤ more than⁤ 14 million people would no longer qualify for cholesterol-lowering statins, and 2.6 million would become ⁢ineligible for blood pressure medications under current treatment guidelines. Specifically, statin recommendations would decrease from 81.8 million to 67.5 million people, with the most important ‍changes affecting men, adults in their 50s and 60s, and Black individuals.

Diao noted a surprising finding: despite the removal of race leading to lower risk assignments for Black Americans, the analysis did not project a disproportionate rise ⁣in heart attacks and strokes in this group. He attributed this to existing disparities⁤ in access to preventive cardiovascular care.

“We thought that if Black individuals became ⁤disproportionately⁢ less eligible for statins, they would be projected to have‍ disproportionately more heart attacks and strokes, but our data did not reflect this expectation,” Diao said. “We think this may be because fewer Black Americans have access ‍to these medications ⁤and to recommended care to begin with. That’s a clear case of two wrongs don’t make a right.”

Manrai emphasized that ⁤treatment decisions shoudl extend beyond risk calculators, incorporating individual factors like family history, lifestyle, ⁤and patient values. He noted that nuanced decision-making is crucial, and people with the same risk level might require different treatment regimens after ⁢careful consideration.

What’s next

The American Heart Association and the American College of Cardiology have not yet officially endorsed the new calculator. Clinicians are urged to consider the potential impact of the new risk assessment tool on treatment eligibility and patient outcomes as they await further guidance.