Your front-page article is wrong to assert that "thousands of people have wrongly been told they are in danger of developing life-threatening heart diseases" because their risk has been miscalculated (1.5m wrongly told they risk heart disease, July 6). The article goes on to imply a link between the prevention of cardiovascular disease and treatment for heart failure, which is hugely misleading and risks alarming a lot of people for no good reason.
The Department of Health is currently looking at a range of options for vascular risk assessment and management, as well as the associated benefits and costs, but no decision has been taken. This is a complex area which requires careful research, and Julia Hippsley-Cox's study on risk scoring, which you reported, is a helpful contribution to the debate.
Professor Hippsley-Cox's work is about refining the way cardiovascular risk might be assessed as part of a prevention strategy; but risk assessment is always a question of the "best available estimate" rather than an absolute measure. So it's misleading to talk about people being "wrongly" assessed as at risk. People who score high on the current system, but who would come in lower on the Hippsley-Cox version, will not stop being at risk of vascular disease even if they move below a given threshold. These people will still benefit from getting advice and, in some cases, medicines to reduce their cholesterol and blood pressure.
The piece suggests that "anti-cholesterol drugs are massively and needlessly over-prescribed", which is wrong. The vast majority of people on statins already have cardiovascular disease. Statins have contributed to the 36% drop in premature deaths from these conditions since 1997, and we estimate that they are saving up to 10,000 lives a year. Their safety profile is so good that they are available over the counter. Generic statins are continuing to drop in price, making them even more cost-effective - the actual NHS bill for statins for 2006-07 comes in at a little over half a billion pounds, a mere quarter of the £2bn claimed in the article.
Heart failure is a separate clinical issue. It involves damage to the heart muscle, often caused when the blood flow to the muscle is interrupted by a heart attack. It is typically - though not exclusively - a disease of older people, so the ageing demographic also contributes to this challenge. It is entirely wrong to infer from the discussions of calculating risk that this group of patients has somehow been "given the wrong treatment". The Healthcare Commission's review of heart-failure services shows that there have been significant improvements in diagnosis and treatment of heart failure since its report in 2005. It also highlights areas where further work is needed. The commission is working with those health communities who scored weakest, and there is a range of complementary policies in place which will all help to address the issues raised.
The one point of contact between accurate risk assessment for cardiovascular disease and treatment of heart failure is that better prevention will reduce the numbers of people who develop heart failure. Conflating these issues does nothing but confuse.
· Professor Roger Boyle is national director for heart disease and stroke.
