July 10, 2006, Houston, Texas -- To accelerate the adoption and standardization of heart
attack screening methods, the July 10th edition of the American
Journal of Cardiology will feature a new practice guideline for screening subclinical
cardiovascular disease in the asymptomatic at-risk population.
Developed by the SHAPE (Screening for Heart
Attack Prevention and Education) Task Force, an international contingent
of leading cardiologists and researchers
organized by the Association for Eradication of Heart Attack,
the SHAPE guideline set revolutionary standards for the careful and responsible
of cardiovascular imaging technologies as part of a comprehensive heart attack
risk assessment and reduction strategy.
The SHAPE guideline calls for non-invasive screening of all asymptomatic men
between ages 45 and 75 and women between ages 55 and 75 to assess their coronary
plaque buildup or carotid wall thickness.
An analysis by the SHAPE Task Force estimates that screening these asymptomatic
men and women could have the following potential outcomes:
"Until SHAPE, there have been no national guidelines for screening subclinical
(hidden) coronary heart disease" said Dr. Morteza Naghavi, chairman of the SHAPE
Task Force who founded the AEHA organization to focus on the eradication of heart
attacks. "We encourage hospitals, diagnostic clinics and physicians to comply
with SHAPE standards and provide their patients with state-of-the-art preventive
Heart attack and stroke account for more death
and disability than all cancers combined. Multiple screening tests
are approved for subclinical cancers such
as mammography and colonoscopy. However, none are approved for subclinical atherosclerosis,
which underlies both heart attack and stroke. This void leaves many individuals – even
those with severe atherosclerosis –unaware of their risk because they have no
"While nearly half of individuals who have heart attacks or sudden death don't
even know they have disease, we already have treatments that could prevent a
large number of these catastrophic events," said Dr. Daniel Berman, director
of Cardiac Imaging at Cedars-Sinai Medical Center and a member of the SHAPE Task
Force Editorial Committee.
This year, more than 500,000 Americans will have a first heart attack, almost
all of which are expected to come from the SHAPE eligible population.
"It is obvious that new strategies are needed to fight the growing epidemic of
atherosclerotic cardiovascular disease," said Dr. Valentin Fuster, past president
of the American Heart Association, and director of the Cardiovascular Institute
at Mount Sinai Medical Center in New York who wrote an editorial commentary in
the special issue of the American College of Cardiology dedicated to the SHAPE
guideline. "By going beyond traditional risk assessment, the SHAPE guideline
has the potential to transform the field of preventive cardiology."
Relying solely on traditional risk factors to identify patients at risk for a
heart attack has proven to be unsuccessful. Many physicians treat patients who
have a huge amount of atherosclerotic plaques (fat buildup in the arteries) the
same way they treat those with no plaques, simply because their risk factor levels
(e.g. cholesterol and blood pressure) are the same. This practice leaves the
high risk patients with an imminent threat of a heart attack or stroke (the Vulnerable
Patient) inadequately protected. Unfortunately, most physicians are unaware of
the threat because they do not measure their patients' plaque burden.
"Traditional risk factors play a major role in treatment for prevention of heart
attack, but they fail to reliably identify individuals at risk of heart attack,
which is best done through assessing the total atherosclerotic plaque volume,
structure and function of the patient's arteries as detailed in the SHAPE guideline," said
Dr. Erling Falk, a pioneering cardiovascular pathologist from Aarhus University
in Denmark who coordinated the Writing Group of the SHAPE Task Force.
Atherosclerosis, a metabolic and inflammatory
disease that causes plaque build up in arteries, is responsible for
nearly all cases of heart attack and most
cases of strokes. Individuals with the highest degree of atherosclerotic plaque
burden are described as "the Vulnerable Patient". Such individuals exhibit no
signs of heart disease and are not identified as very-high-risk by traditional
risk factor assessment.
"With the publication of the SHAPE guideline, we hope to build a new momentum
in cardiology that inspires physicians to use modern technologies for the prevention
of heart attack, rather than using expensive technologies only to treat heart
attack, which is too late and results in too little benefit to the patient," said
Dr. P.K. Shah, director, Division of Cardiology at Cedars-Sinai Medical Center
in Los Angeles who led the SHAPE Task Force Editorial Committee.
While a variety of new tests for the detection
of atherosclerosis and abnormal arterial structure and function are
emerging, the SHAPE Task Force determined
that two – coronary artery calcium (CAC) measured by CT and carotid intima-media
thickness (CIMT) and plaque measured by ultrasonography – currently fulfil established
stringent criteria, including having: 1) abundant evidence for predictive value,
2) availability, 3) reproducibility, 4) complementary value with respect to the
concept of the vulnerable patient, and/or 5) cost-effectiveness relative to the
"We are far from eradicating heart attack, but SHAPE can be a major step to advance
prevention in the field of cardiology," said Dr. Pamela Douglas, Professor and
Chief of Cardiology at Duke University Medical Center and the immediate past
president of the American College of Cardiology. "What we as cardiologists practice
today is mostly sick-care, the future will have to be based on health care, otherwise
the wildly rising cost of medical care will bankrupt our system."
- Prevent more than 90,000 deaths from cardiovascular disease each year.
- Reduce the population with a history of heart
attack – currently estimated
to be 13.2 million – by as much as 25 percent.
- Save approximately $21.5 billion annually by saving those at highest risk,
most of whom are unaware of the danger they are facing.
Publication of the SHAPE Task Force Report was
funded by Pfizer Inc.
The AEHA plans to proliferate SHAPE accredited clinics nationwide. The executive
summary of the SHAPE guideline is available for immediate download at www.AEHA.org.
The SHAPE Task Force Editorial Committee was led by Prediman K. Shah, M.D. and
included (in alphabetic order): Raymond Bahr, M.D., Daniel Berman, M.D., Roger
Blumenthal, M.D., Matthew J. Budoff, M.D., Jay Cohn, M.D., Erling Falk, M.D.,
Ph.D., Ole Faergeman, M.D., Zahi Fayad, Ph.D., Harvey S. Hecht, M.D.,Michael
J. Jamieson, M.D., Wolfgang Koenig, M.D., Ph.D., Daniel Lane, M.D., Ph.D., Naghavi,
John Rumberger, M.D., Ph.D. and Allen J. Taylor, M.D.
The SHAPE Task Force Writing Group was coordinated by Erling Falk, M.D., Ph.D.
and included (in alphabetic order): Juhani Airaksinen, M.D., Dan Arking, Ph.D.,
Juan Badimon, Ph.D., Raymond Bahr, M.D., Daniel Berman, M.D., Matthew J. Budoff,
M.D., Jay Cohn, M.D., Jasenka Demirovic, M.D., Ph.D., George A. Diamond, M.D.,
Pamela Douglas, M.D., Ole Faergeman, M.D., Zahi Fayad, Ph.D., James A. Goldstein,
M.D., Harvey S. Hecht, M.D., Victoria L.M. Herrera, M.D., Michael J Jamieson,
M.D., Sanjay Kaul, M.D., M.P.H., Wolfgang Koenig, M.D., Ph.D., Robert A. Mendes,
M.D., Naghavi, M.D.; Tasneem Z. Naqvi, M.D., Ward A. Riley, Ph.D., Yoram Rudy,
PhD, John Rumberger, M.D., Ph.D., Leslee Shaw, Ph.D., Robert S. Schwartz, M.D.
and Arturo G. Touchard, M.D. Advisors to the SHAPE Task Force included (in alphabetic
order): Arthur Agatston, M.D., Stephane Carlier, M.D., Ph.D., Raimund Erbel,
M.D., Chris deKorte, Ph.D., Craig Hartley, Ph.D., Ioannis Kakadiaris, Ph.D.,
Roxana Mehran, M.D., Daniel O'Leary, M.D., Jan Nilsson, M.D., Gerard Pasterkamp,
M.D., Ph.D., Paul Schoenhagen, M.D. and Henrik Sillesen, M.D., Ph.D. Valentin
Fuster, M.D., Ph.D. served as guest editor.
About AEHA 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 about recent revolutionary discoveries that opened
exciting new avenues to prevent 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.aeha.org.
for Eradication of Heart Attack