From Vulnerable Plaque to Vulnerable Patient-Part III: Executive Summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force Report

Morteza Naghavi, Erling Falk, Harvey S. Hecht, Michael J. Jamieson, Sanjay Kaul, Daniel Berman, Zahi Fayad, Matthew J. Budoff, John Rumberger, Tasneem Z. Naqvi, Leslee J. Shaw, Ole Faergeman, Jay N Cohn, Raymond Bahr, Wolfgang Koenig, Jasenka Demirovic, Dan Arking, Victoria L.M. Herrera, Juan Badimon, James A. GoldsteinYoram Rudy, Juhani Airaksinen, Robert S. Schwartz, Ward A. Riley, Robert A. Mendes, Pamela Douglas, Prediman K. Shah

Research output: Contribution to journalArticlepeer-review

538 Scopus citations

Abstract

Screening for early-stage asymptomatic cancers (eg, cancers of breast and colon) to prevent late-stage malignancies has been widely accepted. However, although atherosclerotic cardiovascular disease (eg, heart attack and stroke) accounts for more death and disability than all cancers combined, there are no national screening guidelines for asymptomatic (subclinical) atherosclerosis, and there is no government- or healthcare-sponsored reimbursement for atherosclerosis screening. Part I and Part II of this consensus statement elaborated on new discoveries in the field of atherosclerosis that led to the concept of the "vulnerable patient." These landmark discoveries, along with new diagnostic and therapeutic options, have set the stage for the next step: translation of this knowledge into a new practice of preventive cardiology. The identification and treatment of the vulnerable patient are the focuses of this consensus statement. In this report, the Screening for Heart Attack Prevention and Education (SHAPE) Task Force presents a new practice guideline for cardiovascular screening in the asymptomatic at-risk population. In summary, the SHAPE Guideline calls for noninvasive screening of all asymptomatic men 45-75 years of age and asymptomatic women 55-75 years of age (except those defined as very low risk) to detect and treat those with subclinical atherosclerosis. A variety of screening tests are available, and the cost-effectiveness of their use in a comprehensive strategy must be validated. Some of these screening tests, such as measurement of coronary artery calcification by computed tomography scanning and carotid artery intima-media thickness and plaque by ultrasonography, have been available longer than others and are capable of providing direct evidence for the presence and extent of atherosclerosis. Both of these imaging methods provide prognostic information of proven value regarding the future risk of heart attack and stroke. Careful and responsible implementation of these tests as part of a comprehensive risk assessment and reduction approach is warranted and outlined by this report. Other tests for the detection of atherosclerosis and abnormal arterial structure and function, such as magnetic resonance imaging of the great arteries, studies of small and large artery stiffness, and assessment of systemic endothelial dysfunction, are emerging and must be further validated. The screening results (severity of subclinical arterial disease) combined with risk factor assessment are used for risk stratification to identify the vulnerable patient and initiate appropriate therapy. The higher the risk, the more vulnerable an individual is to a near-term adverse event. Because <10% of the population who test positive for atherosclerosis will experience a near-term event, additional risk stratification based on reliable markers of disease activity is needed and is expected to further focus the search for the vulnerable patient in the future. All individuals with asymptomatic atherosclerosis should be counseled and treated to prevent progression to overt clinical disease. The aggressiveness of the treatment should be proportional to the level of risk. Individuals with no evidence of subclinical disease may be reassured of the low risk of a future near-term event, yet encouraged to adhere to a healthy lifestyle and maintain appropriate risk factor levels. Early heart attack care education is urged for all individuals with a positive test for atherosclerosis. The SHAPE Task Force reinforces existing guidelines for the screening and treatment of risk factors in younger populations. Cardiovascular healthcare professionals and policymakers are urged to adopt the SHAPE proposal and its attendant cost-effectiveness as a new strategy to contain the epidemic of atherosclerotic cardiovascular disease and the rising cost of therapies associated with this epidemic.

Original languageEnglish (US)
Pages (from-to)2-15
Number of pages14
JournalAmerican Journal of Cardiology
Volume98
Issue number2 SUPPL. 1
DOIs
StatePublished - Jul 17 2006

Bibliographical note

Funding Information:
Chairman: Morteza Naghavi, MD (Association for Eradication of Heart Attack, Houston, Texas). Editorial Committee: ( Chief ) Prediman K. Shah, MD (Cedars-Sinai Medical Center, Los Angeles, California); ( Members ) Raymond Bahr, MD (St. Agnes Hospital, Baltimore, Maryland), Daniel Berman, MD (Cedars-Sinai Medical Center, Los Angeles, California), Roger Blumenthal, MD (Johns Hopkins Hospital, Baltimore, Maryland), Matthew J. Budoff, MD (Harbor-UCLA Medical Center, Torrance, California), Jay Cohn, MD (University of Minnesota, Minneapolis, Minnesota), Erling Falk, MD, PhD (Aarhus University Hospital, Aarhus, Denmark), Ole Faergeman, MD (Aarhus University Hospital, Aarhus, Denmark), Zahi Fayad, PhD (Mount Sinai School of Medicine, New York, New York), Harvey S. Hecht, MD (Lenox Hill Hospital, New York, New York), Michael J. Jamieson, MD (Pfizer Inc., New York, New York), Wolfgang Koenig, MD, PhD (Ulm University, Ulm, Germany), Daniel Lane, MD, PhD (private practice, San Antonio, Texas), Morteza Naghavi, MD (Association for Eradication of Heart Attack, Houston, Texas), John Rumberger, MD, PhD (Department of Medicine [Cardiology], Ohio State University, Columbus, Ohio), Allen J. Taylor, MD (United States Army, Walter Reed Army Medical Center, Washington, DC). Writing Group: ( Coordinator ) Erling Falk, MD, PhD (Aarhus University Hospital, Aarhus, Denmark). ( Members ): Juhani Airaksinen, MD (Turku University Hospital, Turku, Finland), Dan Arking, PhD (Johns Hopkins University School of Medicine, Baltimore, Maryland), Juan Badimon, PhD (Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York), Raymond Bahr, MD (St. Agnes Hospital, Baltimore, Maryland), Daniel Berman, MD (Cedars-Sinai Medical Center, Los Angeles, California), Matthew J. Budoff, MD (Harbor-UCLA Medical Center, Torrance, California), Jay Cohn, MD (University of Minnesota, Minneapolis, Minnesota), Jasenka Demirovic, MD, PhD (University of Texas School of Public Health, Houston, Texas), George A. Diamond, MD (University of California– Los Angeles, Los Angeles, California), Pamela Douglas, MD (Duke University Medical Center, Durham, North Carolina), Ole Faergeman, MD (Aarhus University Hospital, Aarhus, Denmark), Zahi Fayad, PhD (Mount Sinai School of Medicine, New York, New York), James A. Goldstein, MD (William Beaumont Hospital, Royal Oak, Michigan), Harvey S. Hecht, MD (Lenox Hill Hospital, New York, New York), Victoria L. M. Herrera, MD (Boston University School of Medicine, Boston, Massachusetts), Michael J. Jamieson, MD (Pfizer Inc., New York, New York), Sanjay Kaul, MD, MPH (Cedars-Sinai Medical Center, Los Angeles, California), Wolfgang Koenig, MD, PhD (Ulm University, Ulm, Germany), Robert A. Mendes, MD (Pfizer Inc., New York, New York), Morteza Naghavi, MD (Association for Eradication of Heart Attack, Houston, Texas), Tasneem Z. Naqvi, MD (Cedars-Sinai Medical Center, Los Angeles, California), Ward A. Riley, PhD (Wake Forest University School of Medicine, Winston-Salem, North Carolina), Yoram Rudy, PhD (Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri), John Rumberger, MD, PhD (Department of Medicine [Cardiology], Ohio State University, Columbus, Ohio), Leslee J. Shaw, PhD (American Cardiovascular Research Institute, Atlanta, Georgia), Robert S. Schwartz, MD (Minneapolis Heart Institute and Foundation, Minneapolis, Minnesota), Arturo G. Touchard, MD (Minneapolis Heart Institute and Foundation, Minneapolis, Minnesota). Advisors: Arthur Agagston, MD (University of Miami School of Medicine, Miami, Florida), Stephane Carlier, MD, PhD (Columbia University and Cardiovascular Research Foundation, New York, New York), Raimund Erbel, MD (University of Duisburg-Essen, Duisburg, Germany), Chris deKorte, PhD (Erasmus University, Rotterdam, the Netherlands), Craig Hartley, PhD (Baylor College of Medicine, Houston, Texas), Ioannis Kakadiaris, PhD (University of Texas, Houston, Texas), Roxana Mehran, MD (Columbia University and Cardiovascular Research Foundation, New York, New York), Ralph Metcalfe, PhD (University of Texas, Houston, Texas), Daniel O’Leary, MD (Tufts University, School of Medicine, Boston, Massachusetts), Jan Nilsson, MD (Lund University, Lund, Sweden), Gerard Pasterkamp, MD, PhD (Medical Center Utrecht, Utrecht, the Netherlands), Paul Schoenhagen, MD (The Cleveland Clinic Foundation, Cleveland, Ohio), Henrik Sillesen, MD, PhD (Copenhagen University Hospital [Rigshospitalet], Copenhagen, Denmark). Guest Editor: Valentin Fuster, MD, PhD (Cardiovascular Institute and Center for Cardiovascular Health, Mount Sinai Medical Center, New York, New York, and World Health Federation, Geneva, Switzerland).

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