A 49-year old male is transported to your Emergency Department complaining of “tightness” in his chest. He is slightly pale. His skin is warm and dry. He is alert and responsive. His blood pressure is 130/88, and his pulse is 46, strong and regular. He has IV access, and is attached to the ECG monitor which shows sinus rhythm with ST segment elevation in lead II. A stat 12-lead ECG shows 4-6mm ST segmental elevation in leads II, III and aVF. The onset of the patient’s symptoms is less than 30 minutes ago. A member of the team suggests that it would be proper to administer 0.5mg of atropine sulfate I.V. to treat the bradycardia.

The American College of Cardiology/American Heart Association guidelines on assessment of cardiovascular risk1 and on treatment of blood cholesterol, which included recommendations for primary prevention with statins,2 came under intense criticism immediately with their release. Main concerns focused on flawed methods (problems with the risk calculation),3 ethics (conflicts of interest),4 and inferences (too many people offered treatment).

Dr. Steven Nissen, Chairman of the Department of Cardiovascular Medicine at Cleveland Clinic, wrote the following article, which was posted on the Cleveland Clinic's website. Here, he argues that the calculator used to determine whether someone should be on a statin may overestimate risk.