New guidelines that substantially change the assessment and management of cardiovascular disease risk by moving away from specific LDL targets may dramatically overestimate some patients' risk, according to two experts, but the cardiologists who developed the guidelines defended their approach this week. Apparent flaws in the online "risk calculator" that accompanies the ACC/AHA guidelines over-predict the 10-year likelihood of heart attack or stroke, wrote Dr. Paul Ridker and Dr. Nancy Cook in The Lancet. However, Dr. Sidney Smith, executive chairman of the guideline committee, said, "We think we came up with a good risk assessment instrument," while acknowledging in another interview that "we need to see if the concerns raised are substantive."

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