Yet another cardiac risk calculator? My response in the British Medical Journal

~ Carolyn Thomas

by Carolyn Thomas  ♥  @HeartSisters

I was contacted by the British Medical Journal recently,  asking me for a heart patient’s perspective on a new cardiovascular risk calculator.  It’s been launched by the U.K.’s National Health Service (NHS), and claims that it can tell you your real heart age. Here’s what I wrote . . .  

Although the JBS3 risk calculator is designed to be used by physicians and other health care providers to help guide their patients in reducing risks of future heart disease, you can check out this calculator online (entering data fields from before your diagnosis if you’re already a heart patient) and let us know how accurate its predictions were.  (Readers: remember that unless you live in Canada or Europe, change the cholesterol values to mg/dL).

As you can imagine, the accuracy of heart disease risk calculators is tricky, as I’ve written about here, here and here.

And I have yet to find even one so far that even asks about a woman’s history of pregnancy complications (a significant risk factor for heart disease).

Many physicians like the calculator called The Absolute CVD Risk/Benefit Calculator, developed by Dr. James McCormack at Vancouver‘s Therapeutics Education Collaboration (at the University of British Columbia). Internal medicine specialist Dr. John McConnell, for example, calls this one “the best risk calculator I’ve found!”  Mayo Clinic also has a good patient decision aid called The Statin Choice Decision Aid, a tool that can help you and your doctor discuss if you should be taking statin drugs or not.

See also:

Women, controversial statin guidelines, and common sense

Can statins prevent my head from exploding?

Statin guidelines we love to hate – and the docs who write them

My previous blog posts published in the British Medical Journal:  My experience with patient peer review, What I wish I’d known before my hospital discharge, and Why physicians must stop saying “We Are All Patients!“

Can early warning symptoms predict a heart attack?

Women’s early warning signs of a heart attack

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NOTE FROM CAROLYN:  In my book, “A Woman’s Guide to Living with Heart Disease“ (Johns Hopkins University Press, 2017), I wrote much more about women’s risk factors and cardiac warning signs. You can ask for this book at your local library or favourite bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from Johns Hopkins University Press  (Use their code HTWN to get free shipping and save 20% off the list price when you order).

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Q: Heart patients, if you completed the JBS3 calculator, how well did it predict your own diagnosis?

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Published by Carolyn Thomas

25 thoughts on “Yet another cardiac risk calculator? My response in the British Medical Journal”

  1. Hi Carolyn,

    I tried to start the calculator and was going to do it based on info before my first heart attack….my age was not even on there….guess 32 year olds “can’t” have a heart attack.

    I was dismissed from a doctor when I was 29 years old because I could not possibly be having heart problems…. (that it was just my “time of the month.”)

    Well I showed them…had my first heart attack at age 32, my second at age 36, my third at age 40, and my 4th just a few months ago at age 43.

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    1. Marietta, you are the poster child for illustrating that even young women can and do have heart attacks. I’m so sorry that this has happened to you, and I wish you an uneventful recovery (and no more heart attacks, please!)

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  2. Carolyn, when I went to download the app, I saw it was 99 cents. But after reading the comments here I decided I would keep my dollar! 🙂

    It sounds like the app leaves out a lot of important details and may make people think they have nothing to worry about – leading them to make poor choices.

    I agree with you – using common sense and living a healthy life is the best way to go.

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  3. Hmm.. I took it based upon my situation in the week before my heart attack. “You have an 8.3% risk of having a heart attack or stroke in the next 10 years.” I was not able to give my cholesterol figure ..which would have put me more at risk ..but even so ..this is a very flawed idea and I am a little surprised at British Heart Foundation for promoting this.

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  4. Hi Carolyn!
    The calculator isn’t working on my iPad but I can guarantee that my risk of being a cardiac patient was close to zero before the chaos. And then, my chance of being alive today was also close to zero 4 years into the chaos. So I live as best I can in the time I’ve stolen from the grim reaper and that HAS to be enough.

    BTW back at work 10 weeks – it’s like I never left. 🙂

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  5. I’m flying back to St. Louis from the ACC meetings in San Diego and the wifi on this Southwest plane is so slow I can’t really evaluate the JBS3 risk calculator.

    I suspect that is using all the standard risk factors which the ACC/AHA calculator uses and that the numbers will be roughly the same.
    I’ve written on the limitations of any risk assessment that doesn’t incorporate some measure of family history or genetics here.

    The risk calculators do a reasonable job of predicting cardiac events if your problem is lifestyle, but not so good if it is genetics.

    To see what your genetics are doing to your arteries you have to search for subclinical atherosclerosis and incorporate those findings into treatment decisions.

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    1. Hello Dr. Anthony and thanks for adding your perspective. The JBS3 does in fact ask about family history, but precious little about important lifestyle risk factors. Hope you enjoyed your time in San Diego!

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  6. I was curious to take the test but it didn’t seem to work. It said the maximum of good cholesterol I could enter was 77 when mine was 90? A few other glitches as well. I have a stent plus another blocked artery left untouched. This happened a year ago and my bad cholesterol was 147. I weigh 124 lbs, exercise, non smoker and eat well. My risk factor was my mother who had a triple bypass at my age 62. Yet my doctor kept telling me I was in great shape.

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    1. This calculator is meant for those who have not been diagnosed with heart disease. You’d have to enter your data fields with your numbers from before diagnosis, and if you’re not in Canada/Europe, remember to change the cholesterol values to mg/dL instead of mmol/L.

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      1. No. Used the last values. My cholesterol is better now than before. Not much would change. I’ll try again and see what I get. 🙂
        Mary

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        1. The calculator (apparently) only works for those without heart disease who are wondering what their longtime future cardiac risks are, so always enter your pre-MVD/sick sinus syndrome diagnoses numbers. But don’t waste too much time figuring out this calculator, Mary – take JetGirl’s advice (comment above) and just live your life as best you can!

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          1. I’m not worried. Just interested. I taught math and science, and am now the school librarian. I’m always reading and trying to understand MVD and any new research. Currently I’m at the ER at my local hospital. Having trouble with potassium level and have some new arrthymia. Ahh. Fun. At least no angina right now!

            Thanks for a great blog.
            Mary

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  8. Carolyn, I read your article for the British Medical Journal and I think they should offer you an annual, all expense paid trip to England as compensation for your thoroughness, clarity and insights. An excellent review.

    Let me know if you need a companion traveler.

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  9. Hi Carolyn,
    I do a fair bit of trying to help older adults understand their health risks so I found this post very interesting.

    I tried the calculator and like you, it said I’m likely to live to 83. However it also said I have 0.43% chance of a heart attack in the next 10 years. Let’s round it to 0.5% and say I have a 1 in 200 chance of a heart attack. This is very small but it’s not zero, and certainly if you apply it to a large population you still end up with quite a lot of people getting heart attacks.

    I’m not sure just what the best approach to helping people with risk would be. Nobody has a crystal ball, but ideally these calculators give people a ballpark idea of their risk. Now if we want to get more technical we can ask for a confidence estimate around that risk of 1 in 200, but qualitatively many people would still consider it small. Even if you dig up data linking the pregnancy complications to a 3 fold increase in risk, you end up with a 3 in 200 (=1.5%) chance of an event over 10 years. Again, in a million women that turns into 15,000 heart attacks (!), so I don’t want to minimize the problem. But we’re all surrounded by countless small risks, so seems to me it can be hard for both individuals and their clinicians to know which to focus on.

    I agree with you that we do need better risk calculators and we need to do a better job helping people assess their risk. Although many people will blow off a 1 in 200 chance of a heart attack (that’s my personal experience plus borne out by psychology experiments that study how people respond to risk), some will not and they should be offered the opportunity to take action.

    Re why the risk calculators don’t include more important factors, one reason is that they are created by researchers who need to analyze whatever data is at hand. We have a lot of BP, lipid, and hospitalization data, so that what tends to go into the algorithms. Now that we have all these data sensors gathering other info on people’s health and lifestyle, we might see those factors going into the risk calculators.

    Sorry this comment is so long. Always appreciate your blog and thanks for addressing this topic.

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    1. Hi Dr. K and thanks so much for taking the time to add your thoughtful comments! You are so right – what we measure is what gets counted, which is why current cardiac risk calculators ask basically the same questions about BP, cholesterol, family history, and other trackable indicators.

      Yet here’s what I’m curious about: do we really NEED another risk calculator to tell us that we should stop smoking or better manage high blood pressure and weight, and how will this JBS3 calculator be any better at convincing people to take action compared to existing calculators out there?

      I applaud the intention of those who keep inventing risk calculators, of course, but it reminds me of an overheard comment at Stanford Medicine X a few years ago: “Why do we think health tracking apps will work when so far mirrors and bathroom scales have failed?”

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      1. Carolyn,

        As a layperson, I agree that all the calculators, apps, mirrors and scales do not move me to action. What motivates me is what a doctor tells me. My personality doesn’t respond to numbers and statistics – of any sort.

        I am motivated to change my habits when a doctor “lays it on the line” about my health style choices. Most don’t.

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