WASHINGTON – More than 11 million Americans could be inadvertently takingthe wrong heart medication. The trend reveals an even more problematicissue within American healthcare.

New research published this month in Annals of Internal Medicine found thatrisk calculations of people being assessed for atheroscleroticcardiovascular disease were off by, on average, 20 percent.

Black men in particular were at risk of being misestimated.

That means a significant number of patients could be over- or undertreated.This can be dangerous.

Overtreated people could be taking medication unnecessarily, subjectingthemselves to potential side effects as well as throwing money away.

On the other hand, undertreated people are likely not receiving the propertreatment they actually need to prevent things like heart attack and stroke.

In the case of heart disease, there’s a sliding scale of treatment options,including aspirin, blood pressure medication, and statins. Researchersfound that because a significant number of patients were considered to beat high risk through miscalculations, the number of people beingrecommended one or all of these therapies should likely be reduced.

The widespread use of statins among Americans is a hotly debated issue inparticular. As researchers in the BMJ point out, the benefits of statinsfor people with a high risk of cardiovascular disease are undisputed. Butfor those with a lower risk, statin therapy could be unnecessary, evendangerous.

The problem, say researchers, lies in how risk is calculated for disease.

Risk calculators are commonplace in healthcare. They give doctors a simplemeasurement of health to help guide the risks and benefits of a medicationtherapy.

In fact, these calculators are now so easy to find, universities likeHarvard even have them available on the internet for people at home to use.They work by feeding variable data into an equation — in this case, aPooled Cohort Equation (PCE) — to assess a patient’s risk for a givenoutcome. Here, it’s heart disease.

Common variables for calculating risk of heart disease would include aperson’s age, race, sex, height, weight, and health factors includingfamily history, diabetes, and smoking.

Generally, risk calculators are a valuable tool for healthcare. Butresearchers found that when the data and the statistical analysis becomesoutdated, risk estimates can be skewed, resulting in suboptimal care.

“The big message from [this research] is that the way we do these thingsneeds to continue to evolve, and we need to continue to collect better dataand do better calculations so that we can continue to improve the level ofcare,” said Dr. Charles Dinerstein, a senior fellow at the American Councilon Science and Health.

Dinerstein compares the practice of keeping PCE and risk assessmentguidelines up to date like any other infrastructure project.

“If we don’t do it, we’re going to wind up having a medical system thatresembles our bridges that are in various levels of decay,” he said.

Current PCE guidelines were last updated in 2013. They’re updated by theNational Institutes of Health, specifically the National Heart, Lung andBlood Institute.

However, what researchers discovered was that some of the data used even inthese current guidelines was more than 60 years old.

According to senior author Dr. Sanjay Basu of Stanford University, one ofthe data sets used was based on people between the ages of 30 and 62 in1948.

“A lot has changed in terms of diets, environments, and medical treatmentsince the 1940s,” Basu said in a statement. “So, relying on ourgrandparents’ data to make our treatment choices is probably not the bestidea.”

Basu and his team found that by updating both the data sets and the PCE,risk estimates had improved accuracy.

Their research also found that if certain groups aren’t well represented ina data set, their risk assessment will likely be off.

In older data sets, African-Americans weren’t well represented, resultingin risk of heart attack and stroke being underestimated.

“So while many Americans were being recommended aggressive treatments thatthey may not have needed according to current guidelines, some Americans —particularly African-Americans — may have been given false reassurance andprobably need to start treatment given our findings,” Basu said.

Women and other minority groups may also not be represented well in keydata sets.

“Women present with heart attacks differently,” Dinerstein said. “For along time, they were not part of any of the studies for a variety ofreasons. So, their heart disease was largely ignored, because no onethought it was there.”

“If you’re not well represented in the study, there’s going to be some biasin the results,” he said.

Risk calculators serve as guidance to a doctor, but don’t dictate standardof care. Because they’re based on groups — and can be miscalculated, asillustrated by this new research — speaking with your doctor about your ownindividual needs is of utmost importance.

“As long as you have a conversation with your physician and can find outwhether he’s working with the guidelines that are there and whether heagrees or disagrees with how you’re being treated within it, I think yourneeds are met,” Dinerstein said.

“The most personalized medicine you can get is having a conversation withyour doctor.”