Preventive Cardiology: the SHAPE of the future. A Synopsis from the Screening for Heart Attack Prevention and...

Traditional guidelines for prevention of atherosclerotic cardiovascular disease (ACVD) fail to identify very-high-risk individuals (the vulnerable patient) who have extensive atherosclerotic plaques in coronary and other arteries thereby at risk for a near future adverse event. They solely rely on screening for traditional risk factors of atherosclerosis (e.g., cholesterol, blood pressure, smoking, etc.) and do not treat differently those with and without extensive atherosclerotic plaques who have a similar risk factor profile (e.g., Framingham Risk Score). Recent studies have consistently shown that individuals with extensive plaque burden regardless of their risk factor profile are very high risk. Traditional risk factor-based guidelines clearly miss to identify the vulnerable patient whose risk factor profile is normal or borderline (i.e., low- or intermediate-risk categories). Often individuals with similar risk factor profiles have different levels of coronary plaque burden and are on different trajectories for a future cardiovascular event. Risk factors of atherosclerosis are at best predictors of ACVD but cannot identify who has or does not have the disease. While such an approach was the best available method in the 70s and 80s, we now have new noninvasive tools capable of detecting atherosclerosis itself. The existing traditional guidelines for primary prevention of ACVD need to be updated to save the vulnerable patient. To address this problem, the Association for Eradication of Heart Attack, a grassroots organization founded by a group of cardiovascular physicians and researchers, has proposed the SHAPE (Screening for Heart Attack Prevention and Education) guideline based on consensus among an international group of distinguished cardiovascular experts. The SHAPE guideline aims to complement existing guidelines in preventive cardiology and address the detection and treatment of the vulnerable patient. The SHAPE Task Force has thoroughly reviewed available evidence including recent studies and recommended that all asymptomatic men 45-75 years and women 55-75 years (except for a small group < 5% with a very low risk factor profile) must undergo noninvasive screening to detect and measure the amount of hidden atherosclerotic plaques in their coronary or carotid arteries. The higher the amount of plaques the more intensive treatment is recommended. The SHAPE Task Force urges health-care policy makers to update existing national guidelines for primary prevention of atherosclerotic cardiovascular disease.