Leaders in Cardiology from AEHA's National SHAPE Task Force Propose New Approach to Advance Heart Attack Prevention
Addressing the Practice of Cardiovascular Screening in Apparently Healthy People Will Be a Hot Topic March 5th on the Eve of the Annual Conference of American College of Cardiology
ORLANDO, Fla., March 3, 2005 -- The SHAPE Task Force organized by the Association for Eradication of Heart Attack (AEHA) will recommend a new screening guideline that it hopes will revolutionize how doctors currently evaluate an individual's risk of heart attack. The 1st National SHAPE (Screening for Heart Attack Prevention and Education) Guideline will be the subject of a satellite symposium held March 5, 2005 in conjunction with the 54th Annual Scientific Session of the American College of Cardiology (ACC 05) in Orlando, Fla.
"Scientific understanding of the causal chain of heart attack has advanced along with technologies capable of improving our ability to identify those at risk, but our physicians lack new guidelines for using the latest knowledge and technology to actually prevent heart attacks," said Dr. Morteza Naghavi, chairman of the SHAPE Task Force who founded the AEHA organization to focus on the eradication of heart attacks. "Every year, nearly half of heart attack victims (over 650,000 only in the United States) are unaware of their vulnerability to a near future heart attack until it happens. And more than 220,000 of them die within an hour; this is unacceptable. Essentially, they each are a walking time bomb and completely unaware."
"The SHAPE Guideline is a new approach based on identification of subclinical atherosclerosis as a first step and then incorporating additional information derived from traditional risk factors of the disease with the option of incorporating additional new and emerging biomarkers," said Dr. P.K. Shah, director, Division of Cardiology at Cedars Sinai Medical Center in Los Angeles who also chairs the SHAPE Task Force Editorial Committee. "It is designed to improve our ability to identify 'the Vulnerable Patient,' individuals at risk of a heart attack in the near future who do not exhibit overt signs and symptoms of cardiovascular disease.
Modeled after successful screening efforts in the cancer care arena, the 1st National SHAPE Guideline encourages virtually all men 45 and older and women 55 and older to undergo screening for subclinical atherosclerosis to determine their future risk of a heart attack. The only portion of the population exempted from this universal screening recommendation are those classified as "very low risk" who satisfy all of the following criteria: cholesterol lower than 200(mg/dl), blood pressure lower than 120 over 80 (mmHg), no history of any type of diabetes, no smoking, and no family history of heart attack.
"Unfortunately, a very small number of people in the United States and most industrial countries are in this very low risk category," said Dr. Erling Falk, a leading cardiovascular pathologist from Aarhus University in Denmark who led the Writing Group of the SHAPE Task Force. "And, despite public health efforts to encourage lifestyle modification, the proportion of this category to the total population has constantly decreased during the past few decades."
"We now have effective therapies to prevent heart attacks - but the key to their prevention is identification of patients who are at increased risk and thus in need of immediate therapy," said Dr. Daniel Berman professor of medicine at UCLA a member of the SHAPE Task Force.
Today, two methods are widely available to help doctors evaluate the presence and extent of subclinical atherosclerosis, which is also referred to as plaque buildup and thickening in the arteries. In the future additional non-invasive technologies that can detect abnormal structure and function of the arteries in the body are also likely to play a role in this screening process:
-- Coronary calcium score using a CT scan, which is used to determine the burden of plaque build-up in the coronary arteries; and
-- Thickness of the carotid artery wall and presence of plaque measured by ultrasound, which correlates with an individual's total burden of arterial plaque build-up or atherosclerosis.
For Those Who Test Negative For Subclinical Atherosclerosis
The 1st National SHAPE Guideline defines a negative test as a person with a coronary calcium score (CCS) of zero or carotid intima-media thickness (CIMT) lower than the 50th percentile. If the subject does not have established risk factors, the Guideline categorizes them as Lower Risk and recommends retesting in five years. But if any of the traditional risk factors exist, the Guideline categorizes them as Moderate Risk and recommends treating the risk factors according to existing guidelines and also retesting in five years.
For Those Who Test Positive For Subclinical Atherosclerosis
Those with a CCS greater than zero or a CIMT higher than the 50th percentile are classified as testing positive for subclinical atherosclorosis. The 1st National SHAPE Guideline breaks this population into three sub-groups: Moderately High Risk, High Risk, and Very High Risk.
- Moderately High Risk: Those who have a CCS greater than zero but less than 100 and less than the 75th percentile, or a CIMT between the 50th and 75th percentile and no discernable plaque buildup.
- High Risk is defined by having a CCS greater than the 75th percentile or greater than 100. These patients are considered as appropriate for aggressive lifestyle modifications to a lower target low-density lipoprotein (LDL) cholesterol. If the CCS is greater than 400 or greater than the 90th percentile, additional testing for myocardial ischemia is recommended. High Risk patients with no evidence of poor blood flow in the heart muscle (ischemia) are still treated to an even lower LDL goal than the patients with less extensive atherosclerosis (LDL less than 70). Those who test for ischemia fall into the very high-risk group.
- Very High Risk is defined by having an abnormal test for ischemia. The National SHAPE Guideline recommends that these patients undergo coronary angiography. This group also requires the most aggressive therapy.
AEHA and its SHAPE Task Force are made up of leading cardiologists and researchers from around the world. They share the belief that current guidelines that are solely based on an inventory of traditional risk factors fall short in alarming individuals at risk of a near future heart attack. Current guidelines can be further improved by incorporating knowledge regarding presence and severity of subclinical atherosclerosis.
The AEHA SHAPE Task Force is chaired by Morteza Naghavi, M.D., founder and president of AEHA.
The Editorial Committee includes: P. K. Shah, M.D. (Chair), Raymond Bahr, M.D., Daniel Berman, M.D., Matthew Budoff, M.D., George Diamond, M.D., Erling Falk, M.D., Ph.D., Ole Faergeman, M.D., Zahi A. Fayad, Ph.D., Harvey Hecht, M.D. Victoria Herrera, M.D., Wolfgang Koenig, M.D., Ph.D., Daniel Lane, M.D., Ph.D., Michael Jamieson, M.D., Morteza Naghavi, M.D. and John Rumberger, M.D., Ph.D.
The Writing Group includes: Erling Falk, M.D., Ph.D. (Coordinator); Juhani Airaksinen, M.D. Dan Arking, Ph.D., Juan Badimon, Ph.D., Raymond Bahr, M.D., Daniel Berman, M.D., Mathew Budoff, M.D., Jasenka Demirovic, M.D., Ph.D., George Diamond, M.D., Pamela Douglas, M.D., Ole Faergeman, M.D., Zahi A. Fayad, Ph.D., Harvey Hecht, M.D., Victoria Herrera, M.D., Sanjay Kaul, M.D., M.P.H., Wolfgang Koenig, M.D., Ph.D., Morteza Naghavi, M.D.; Tasneem Z. Naqvi, M.D., Yoram Rudy, Ph.D., John Rumberger, M.D., Ph.D., Leslee Shaw, Ph.D. and Robert Schwartz, M.D.
The Advisors includes: Roger Blumenthal, M.D., Stephane Carlier, M.D., Ph.D., Roxana Mehran, M.D., Allen Taylor, M.D. and Henrik Sillesen, M.D.
The 1st National SHAPE Guideline will be presented at the 8th Vulnerable Patient Symposium, March 5, 2005 at the Double Tree Castle Hotel; 8629 International Dr., Orlando, Fla. Onsite registration will begin at 2:00 p.m. with the program beginning at 3:00 p.m.
Originated from the Texas Medical Center in Houston, the AEHA is a non-profit organization that promotes education and research related to mechanism, prevention, detection and treatment of heart attacks. The organization is committed to raising public awareness and research funding to support new developments that can lead to eradication of heart attack. The AEHA's mission is to eradicate heart attacks before the end of the century. Additional information is available on the organization's Web site at www.vp.org and www.AEHA.org.
About the SHAPE Task Force
The following world-renowned cardiovascular specialists and researchers from around the world have agreed to participate in AEHA's SHAPE initiative providing their expertise in various areas of cardiovascular science and technology to help prepare a comprehensive guideline for screening and prevention of heart attack.