So why wasn’t inflammatory arthritis included in the calculator? Eric Matteson, MD, chair of the division of rheumatology at Mayo Clinic, says, “I think it is because the guideline authors don’t think there is enough evidence about the effect of statins on inflammatory conditions, above and beyond what is already known about the benefits of statins for people with high cholesterol, diabetes and the other conditions identified in [the risk calculator].”

Because of  that omission, “the new guidelines would likely result in fewer RA patients being treated than actually would benefit from a statin,” says Dr. Giles.

If you have inflammatory arthritis, your doctor should recognize that you are at increased risk for CVD, and “do whatever is best to get inflammation under control, and that is usually a statin,” says Dr. Pisetsky.

Dr. Matteson adds, you as a patient should talk to your doctor about your possible heart disease risk.

While the guidelines may underestimate the danger in some, they have sparked a heated controversy because they may overestimate it in many others. According to Dr. Matteson, “There is concern that 7 to 8 percent of people who are not at risk for cardiovascular disease may be identified by the risk calculator as being at risk, and put on statins unnecessarily.”

As Dr. Pisetsky explains it, “The new calculator has raised concern because it would lead to more treatment. But it may also lead to greater risk reduction.” The glitch, he says, is that “that’s not proven.”  

“To prevent an event,” says Dr. Pisetsky, “you’re always going to treat more people than you need to. The challenge is always to figure out what’s the right number –who to treat and who not to treat.” Not everyone is convinced that the calculator delivers the best answer.

Statins or no statins, the guidelines remind doctors and patients that lifestyle changes, such as eating right and getting regular exercise, are still important. “A primary message of the new guidelines is, ‘Heart healthy lifestyle habits are the foundation of [atherosclerotic cardiovascular disease] prevention,’” says Dr. Giles.