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 Cohn, Raymond Bahr, Wolfgang Koenig, Jasenka Demirovic, Dan Arking, Victoria L M Herrera, Juan Badimon, James A. Goldstein & 7 others Yoram Rudy, Juhani Airaksinen, Robert S. Schwartz, Ward A. Riley, Robert A. Mendes, Pamela Douglas, Prediman K. Shah

Research output: Contribution to journalArticle

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

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

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Advisory Committees
Atherosclerosis
Myocardial Infarction
Education
Consensus
Arteries
Stroke
Guidelines
Neoplasms
Carotid Intima-Media Thickness
Translational Medical Research
Risk Reduction Behavior
Cardiology
Carotid Arteries
Practice Guidelines
Colonic Neoplasms
Cost-Benefit Analysis
Ultrasonography
Coronary Vessels
Cardiovascular Diseases

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

From Vulnerable Plaque to Vulnerable Patient-Part III : Executive Summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force Report. / Naghavi, Morteza; Falk, Erling; Hecht, Harvey S.; Jamieson, Michael J.; Kaul, Sanjay; Berman, Daniel; Fayad, Zahi; Budoff, Matthew J.; Rumberger, John; Naqvi, Tasneem Z.; Shaw, Leslee J.; Faergeman, Ole; Cohn, Jay; Bahr, Raymond; Koenig, Wolfgang; Demirovic, Jasenka; Arking, Dan; Herrera, Victoria L M; Badimon, Juan; Goldstein, James A.; Rudy, Yoram; Airaksinen, Juhani; Schwartz, Robert S.; Riley, Ward A.; Mendes, Robert A.; Douglas, Pamela; Shah, Prediman K.

In: The American Journal of Cardiology, Vol. 98, No. 2 SUPPL. 1, 17.07.2006, p. 2-15.

Research output: Contribution to journalArticle

Naghavi, M, Falk, E, Hecht, HS, Jamieson, MJ, Kaul, S, Berman, D, Fayad, Z, Budoff, MJ, Rumberger, J, Naqvi, TZ, Shaw, LJ, Faergeman, O, Cohn, J, Bahr, R, Koenig, W, Demirovic, J, Arking, D, Herrera, VLM, Badimon, J, Goldstein, JA, Rudy, Y, Airaksinen, J, Schwartz, RS, Riley, WA, Mendes, RA, Douglas, P & Shah, PK 2006, 'From Vulnerable Plaque to Vulnerable Patient-Part III: Executive Summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force Report', The American Journal of Cardiology, vol. 98, no. 2 SUPPL. 1, pp. 2-15. https://doi.org/10.1016/j.amjcard.2006.03.002
Naghavi, Morteza ; Falk, Erling ; Hecht, Harvey S. ; Jamieson, Michael J. ; Kaul, Sanjay ; Berman, Daniel ; Fayad, Zahi ; Budoff, Matthew J. ; Rumberger, John ; Naqvi, Tasneem Z. ; Shaw, Leslee J. ; Faergeman, Ole ; Cohn, Jay ; Bahr, Raymond ; Koenig, Wolfgang ; Demirovic, Jasenka ; Arking, Dan ; Herrera, Victoria L M ; Badimon, Juan ; Goldstein, James A. ; Rudy, Yoram ; Airaksinen, Juhani ; Schwartz, Robert S. ; Riley, Ward A. ; Mendes, Robert A. ; Douglas, Pamela ; Shah, Prediman K. / From Vulnerable Plaque to Vulnerable Patient-Part III : Executive Summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force Report. In: The American Journal of Cardiology. 2006 ; Vol. 98, No. 2 SUPPL. 1. pp. 2-15.
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AU - Naghavi, Morteza

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AU - Hecht, Harvey S.

AU - Jamieson, Michael J.

AU - Kaul, Sanjay

AU - Berman, Daniel

AU - Fayad, Zahi

AU - Budoff, Matthew J.

AU - Rumberger, John

AU - Naqvi, Tasneem Z.

AU - Shaw, Leslee J.

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AU - Cohn, Jay

AU - Bahr, Raymond

AU - Koenig, Wolfgang

AU - Demirovic, Jasenka

AU - Arking, Dan

AU - Herrera, Victoria L M

AU - Badimon, Juan

AU - Goldstein, James A.

AU - Rudy, Yoram

AU - Airaksinen, Juhani

AU - Schwartz, Robert S.

AU - Riley, Ward A.

AU - Mendes, Robert A.

AU - Douglas, Pamela

AU - Shah, Prediman K.

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