How to Prevent 500,000 Heart Attacks a Year

Why is cardiovascular disease still the number one killer in the Western World when risk factors are well known and risk-reduction strategies are widely available?

The Screening for Heart Attack Prevention and Education (SHAPE) Task Force has an answer. This group of leading cardiologists says that focusing on the identification and treatment of known risk factors is ineffective at identifying individuals at greatest risk for heart attack and stroke. Instead, they say, a prevention policy based on identifying cardiovascular disease (CVD) long before symptoms appear would be far more effective at identifying vulnerable patients and preventing the consequences. It's estimated that initially, 50 million people could qualify for screening.

What's wrong with current guidelines?

Current guidelines do not recognize nonobstructive coronary atherosclerosis as a risk equivalent for coronary artery disease, even though most heart attacks are caused by nonobstructive plaques.

Rather, current guidelines measure risk indirectly through factors known to influence risk, such as smoking, high blood pressure and high cholesterol. The problem is that most people in the U.S. over age 40 have one or more risk factors, whether they develop CVD or not. When risk factors are so widely present, they are no longer effective in predicting the development of CVD in individuals. Additionally, current guidelines are good at identifying people at very low or very high risk of having a heart attack or stroke within 10 years. However, most people fall into an intermediate risk group, and most heart attacks occur in this group.

An ounce of prevention may be better.

The widely accepted practice of screening for asymptomatic cancers of the breast and colon to identify early disease has drastically reduced deaths from these causes. The SHAPE Task Force advocates the same approach with CVD. Screening men and women with no symptoms would enable thousands of people who are unaware they have atherosclerosis, and who are vulnerable to heart attack or stroke, to be identified. The severity of their asymptomatic disease could be combined with assessment of known risk factors to pinpoint at-risk patients who need treatment, which could be individualized in proportion to risk.

WHAT YOU CAN DO SHAPE guidelines recommend:

Noninvasive screening of all asymptomatic men aged 45-75 and asymptomatic women aged 55-75.
Measuring carotid intima media thickness (CIMT) with ultrasound and coronary artery calcification score (CACS) with CT
Further tests based upon evaluation (Low Risk or High Risk).

FAST FACTS

Screening men and women with no symptoms would enable thousands of people who are unaware they have atherosclerosis, and who are vulnerable to heart attack or stroke, to be identified.Such a screening program could drastically reduce the large number of first heart attacks—about 875,000—suffered every year. If all of the 50 million qualified were screened, the Task Force estimates 500,000 heart attacks and thousands of strokes per year could be prevented.