SHAPE guidelines
- From: MarilynMann <mannm@xxxxxxxxxxx>
- Date: 19 Apr 2007 09:19:25 -0700
The Screening for Heart Attack Prevention and Education (SHAPE) task
force has published a new report recommending screening for
subclinical atherosclerosis, using computed tomography (CT), carotid
artery ultrasonography, or both, for all asymptomatic "at-risk" men
aged 45 to 75 years and women aged 55 to 75 years.1 Their stated
rationale is that while screening for early-stage, asymptomatic
cancers, such as breast and colon cancer, is widely accepted, and
although atherosclerotic cardiovascular disease is responsible for
more death and disability than all cancers combined, there are no
national guidelinesΓÇöand no public or private fundingΓÇöfor screening
to identify people with asymptomatic atherosclerosis. This
report is the third in a 3-part series 2, 3 from Dr.
Morteza Naghavi, chairman, and his colleagues on the SHAPE task
force.
Parts I and II of this consensus statement elaborated on new
discoveries
in the field of atherosclerotic vascular disease that led to the
concept
of the "vulnerable patient." The SHAPE document outlines the
appropriate
use of imaging technology: particularly, CT to measure coronary
artery
calcium and ultrasonography to measure carotid intima-media
thickness.
The document calls attention to a recent scientific statement issued
by
the American Cancer Society, American Heart Association, and American
Diabetes Association, which initiated their new collaborative effort
dedicated to the prevention and early detection of cancer,
cardiovascular
disease (CVD), and diabetes.4 There are screening recommendations
for
breast cancer, cervical cancer, colorectal cancer and prostate
cancer. The task force points out that "in contrast to cancer, early
detection of CVD by screening with the best available technology is
not mentioned, despite the >500,000 deaths per year from
atherosclerosis, compared with ~57,000 from colorectoanal cancer,
~42,000 from breast cancer, and ~31,000 from prostate cancer."1 The
report goes on to discuss the limitations of the current guidelines
for primary prevention of CVD,5-8 which all recognize groups of
asymptomatic patients who are at high risk. Furthermore, as the task
force points out, the current guidelines 6 allow the use of
noninvasive screening tests for additional risk assessment of
"appropriately selected" individuals "at the physician's discretion."
The SHAPE task force, therefore, proposes that all apparently healthy
men aged 45 to 75 years and women aged 55 to 75 years, with no known
history of coronary heart disease (CHD) and not considered to be at
very low risk, undergo screening for atherosclerosis.
Very low risk is defined by the absence of any of the following:
total
cholesterol level >200 mg/dL, blood pressure >120/80 mm Hg,
diabetes mellitus, smoking, family history of CHD, and the metabolic
syndrome. The SHAPE writing group estimates that of the more than 61
million Americans within this age range, almost 4 million have
established CHD, and that the proportion at very low risk is only 5%
to 10%,9 leaving 50 million people who should be screened, according
to the SHAPE guidelines. It is important to note that although the
report announces itself as a "new practice guideline for
cardiovascular screening," some voices have been raised to say quite
clearly that these guidelines are just "an
opinion." The lead author, Dr. Naghavi, is also the founder and
president
of Association for Eradication of Heart Attack (AEHA),(http://
www.aeha.org/), a not-for-profit organization dedicated to ending
myocardial infarction (MI) by advancing the science and the practice
of MI
prevention, detection, and treatment. The AEHA created the SHAPE
task
force and is thus the sponsor of its reports and guidelines.
References
1. Naghavi M, Falk E, Hecht HS, et al. From vulnerable plaque
to
vulnerable patientΓÇöPart III: Executive summary of the
Screening for Heart
Attack Prevention and Education (SHAPE) task force report. Am J
Cardiol.
2006;98:2H-15H.
2. Naghavi M, Libby P, Falk E, et al. From vulnerable plaque to
vulnerable
patient: a call for new definitions and risk assessment
strategies: Part
I. Circulation. 2003;108:1664-1672.
3. Naghavi M, Libby P, Falk E, et al. From vulnerable plaque to
vulnerable
patient: a call for new definitions and risk assessment
strategies: Part
II. Circulation. 2003;108:1772-1778.
4. Eyre H, Kahn R, Robertson RM, et al. Preventing cancer,
cardiovascular
disease, and diabetes: a common agenda for the American Cancer
Society,
the American Diabetes Association, and the American Heart
Association.
Circulation. 2004;109:3244-3255.
5. De Backer G, Ambrosioni E, Borch-Johnsen K, et al. European
guidelines
on cardiovascular disease prevention in clinical practice. Third
Joint
Task Force of European and Other Societies on Cardiovascular
Disease
Prevention in Clinical Practice. Eur Heart J. 2003;24:1601-1610.
6. Executive Summary of The Third Report of The National
Cholesterol
Education Program (NCEP) Expert Panel on Detection, Evaluation,
And
Treatment of High Blood Cholesterol in Adults (Adult Treatment
Panel III).
JAMA. 2001;285:2486-2497.
7. Smith SC, Jr, Greenland P, Grundy SM. AHA Conference
Proceedings.
Prevention conference V: Beyond secondary prevention:
Identifying the
high-risk patient for primary prevention: executive summary.
American
Heart Association. Circulation. 2000;101:111-116.
8. Grundy SM, Cleeman JI, Merz CNB, et al. Implications of
recent clinical
trials for the National Cholesterol Education Program Adult
Treatment
Panel III guidelines. Circulation. 2004;110:227-239.
9. Stamler J, Stamler R, Neaton JD, et al. Low risk-factor
profile and
long-term cardiovascular and noncardiovascular mortality and
life
expectancy: findings for 5 large cohorts of young adult and
middle-aged
men and women. JAMA. 1999;282:2012-2018.Steering Committee
This sounds like a lot of screening!
Marilyn
.
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