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SHAPE Task Force Warns of "Massive Overtreatment" From AHA's New Guidelines on CVD Prevention in Women


February 22, 2011 - HOUSTON, TX

SHAPE, The Society for Heart attack Prevention and Eradication (http://www.shapesociety.org), a nonprofit organization that promotes early detection and preventive intervention to eradicate heart attacks, today issued a letter to the Circulation Journal and the New England Journal of Medicine expressing concerns about the 2011 update to the American Heart Association's guideline for the prevention of cardiovascular disease (CVD) in women. By arbitrarily lowering and deflating the cut-off point for the High Risk category from 20 percent to 10 percent and continuing to rely solely on traditional risk factors to measure an individual's risk, the new guideline could result in massive overtreatment and undue "High Risk" labeling of many otherwise healthy women.

"The primary reason our existing national CVD prevention guidelines do not work in women is not because the guidelines have a high threshold but because they are based on less than precise measures of the disease," said Dr. PK Shah, chairman of the SHAPE Scientific Board who is also a Professor of Medicine at UCLA and Director of Cardiology at Cedars-Sinai Heart Institute and Medical Center in Los Angeles. "Measuring traditional risk factors alone is not enough to characterize atherothrombotic risk especially in intermediate risk cohorts. Such patients could benefit from a more individualized risk assessment when measures of subclinical atherosclerosis are included in the risk prediction strategy."

Existing guidelines inexplicably hesitate to exploit the full benefit of testing for subclinical atherosclerosis in the primary prevention of CVD. This is the missing piece.

"To prevent massive overtreatment and undue 'high risk' labeling of healthy women, SHAPE is urging the new AHA guideline be amended to incorporate the responsible use of scientifically proven noninvasive tests for subclinical atherosclerosis," said Erling Falk, M.D., Ph.D., chief of the SHAPE Task Force II Editorial Committee, who is also Professor of Cardiovascular Pathology at Aarhus University Hospital in Denmark.

The SHAPE Task Force encourages physicians to use either coronary artery calcification scoring (CACS) by a CT scan or carotid artery intima-media thickness (CIMT) and plaque scanning by ultrasound. By implementing screening for asymptomatic atherosclerosis in women age 55 and older who have a Framingham Risk Score of six percent or greater, physicians can significantly improve their risk assessment and take appropriate preventive measures.

By relying solely on traditional risk factors, the new guideline also contradicts the recommendations in the "2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults," in which testing for subclinical atherosclerosis through CACS or CIMT received a strong evidence-based (Level IIa) recommendation.

"While we laud the intentions of the revised AHA guideline, SHAPE believes that the best way to accurately determine an individual's risk for atherosclerotic cardiovascular events is to encourage them to have an atherosclerosis test," said Mathew Budoff, M.D., Professor of Medicine at the David Geffen School of Medicine at UCLA.

About SHAPE
Based in Houston, the Society for Heart attack Prevention and Eradication (SHAPE) is a non-profit organization that promotes research and education for early detection and treatment of healthy-looking individuals who are at risk of a future heart attack or stroke. SHAPE is committed to raising public awareness about revolutionary discoveries that are opening exciting avenues to prevent, treat and ultimately eliminate atherosclerotic cardiovascular disease. SHAPE's mission is to eradicate heart attacks in the 21st century. Additional information is available on the organization's website at www.shapesociety.org.

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