SHAPE Guidelines bring CT heart scans to forefront
We believe the time has come to replace the traditional, imprecise risk factor approach to individual risk assessment in primary prevention with an approach largely based on noninvasive screening for the disease itself…
The SHAPE Task Force Report
American Journal of Cardiology, July 17, 2006
On July 17, 2006, the national
experts of the Screening for Heart Attack Prevention and
Education (SHAPE) Task Force released guidelines for heart
disease detection in the American public.
Why is that news? Aren’t there already guidelines in place for
heart disease detection?
Shockingly, there are not. There are guidelines for heart
disease risk factor assessment, but no set of guidelines that
incorporate measures of atherosclerosis itself—a crucial
distinction.
Though precedents for broad screening for colon cancer using
colonoscopy and breast cancer with mammography and self-exam
have already been established, no such broad guidelines have
existed for coronary heart disease―until now.
Among the experts involved in drafting the guidelines: Heart
disease imaging expert, Daniel Berman, MD, of UCLA; Mayo Clinic
internationally-known heart disease researcher, Robert S.
Schwartz, MD; Track Your Plaque friend John Rumberger, MD, PhD;
and 24 others. After several years of discussion and
disappointment with existing guidelines from the American Heart
Association (which focus exclusively on cholesterol and
lifestyle issues), the SHAPE guidelines were drafted to include
imaging technologies that detect and quantify atherosclerotic
disease. The guidelines state:
Because screening to identify subclinical or asymptomatic
atherosclerosis could confer great public health benefit, it
may seem surprising that it has not yet been incorporated into
national and international clinical guidelines.
The guidelines highlight the failure of conventional risk
factors to confidently identify high-risk individuals, what
they call “the vulnerable patient”. They stress that heart
attacks “occur in patients who are not receiving the benefits
of preventive therapies of proven efficacy because their
arterial disease was unrecognized (asymptomatic) and/or they
had been misclassified by conventional risk factors and
assigned a treatment goal at odds with their actual burden of
atherosclerosis.”
The guideline authors do a wonderful job of detailing how and
why the conventional approach of using risk factors fails all
too frequently. They point out that the very same set of risks
in one person can predict a very different risk in another
person. “The relation between cigarette smoking and lung cancer
provides a reasonable analogy: When almost everyone in a given
population smokes, smoking itself fails to predict the risk of
cancer.”
If you’re already an adherent to the Track Your Plaque program,
you’ll actually find little new in the SHAPE report. What is
new is that the concept of early atherosclerotic plaque
detection is catching on throughout the nation. The SHAPE Task
Force guidelines will help fuel this phenomenon.
Though we’re very grateful for the hard work of the guidelines’
authors and the impact this report will likely have worldwide,
a discussion of how to stop or reduce heart scan scores is
still painfully missing from the conversation. That’s why we
advocate the Track Your Plaque approach and detection of
disease is only the first step!
There are many steps that should follow, all with the goal of
stopping or reducing your heart scan score as a means of trying
to eliminate your risk for heart attack. Perhaps someday in
future you’ll read about the Track Your Plaque Task Force
guidelines in the newspaper! But until then you’ll have to
continue to get it here.
Copyright 2006, Track Your Plaque.