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In this issue:
- Elevated Lp-PLA2 levels predict risk of coronary heart disease above and beyond traditional risk factors & C reactive protein
- Hypertension trends no longer reducing in
- Intrathoracic and pericardial fat independently associated with local vascular atherosclerosis
- Patients with obstructive sleep apnea have higher likelihood of subclinical atherosclerosis
- Non-invasive
contrast enhance coronary CT identifies high prevalence of obstructive
and non obstructive coronary artery disease in diabetic patients
- Differential
association of cardiovascular risk factors with subclinical
cardiovascular disease observed across different Hispanic ethnic groups
in USA
- High LDL More strongly related to increased subclinical atherosclerosis among those with high blood pressure
- Ban on smoking reduces acute coronary heart disease events in Italy
- Medication non-adherence results in poor blood pressure control in patients with coronary artery disease
SHAPE encourages debate over CTA & CAC covered in Circulation In the latest issue of Circulation published on March 10th
2008, a section was dedicated in discussion of the pros and cons of
advanced screening of high risk asymptomatic individuals with contrast
enhanced computed tomography angiography (CTA). Currently the evidence
is well established for assessing coronary artery calcification (CAC)
by non contrast CT that also uses very low radiation compared to CTA.
The guidelines for using CAC as a method to refine coronary heart
disease risk assessment in high risk asymptomatic individuals were
first proposed in 2006, by the experts in the Society of Heart Attack
Prevention and Education Taskforce (SHAPE-Taskforce) and followed by
both American Heart Association and American College of Cardiology in
2007. Gottlieb and Lima
et al from Johns Hopkins Hospital acknowledged the role of SHAPE in
establishing these guidelines in their latest view point published in
Circulation. The study’s authors highlighted key findings of the very
specific algorithms (for screening asymptomatic men aged >45 years
and women aged >55 years who would not otherwise be considered as high risk on
the basis of the coronary heart disease risk equivalent criteria. The
SHAPE Guideline recommends a combination of clinical based risk
assessment to be modified by carotid ultrasound imaging and/or CAC
assessment which has the potential impact of reducing sudden death and nonfatal myocardial infarction in the United States in a cost effective manner. In
recent years the SHAPE Guidelines have been increasingly mentioned in
top rated journals as a mean to reduce the societal burden of CHD,
evidence of the increased desire to optimize risk stratification. We
encourage these much needed scientific debates and are pleased that our
proposed guideline continues to inspire those seeking advancement in
the field of preventive cardiology. Click here for full article.
Approaches to SHAPE the Future of Primary Prevention: The New Framingham Risk Score and Beyond
SHAPE Dinner Symposium at ACC 08: Dr. Fuster presents the SHAPE Lifetime Achievement Award to Dr. Levy of Framingham Heart Study and Dr. Akosah of U.Va.
Expert group recognize the utility of carotid ultrasound in primary CHD risk stratification strategies.
Stein JH, Korcarz CE, Hurst RT, Lonn E, Kendall CB, Mohler ER, Najjar SS, Rembold CM, Post WS; American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr. 2008 Feb;21(2):93-111
Aim: The consensus statement aim to provide recommendations for the use of carotid ultrasound to assess subclinical vascular disease and CVD risk.
Methods:
- The expert committee reviewed available evidence to provide recommendation for methods assessing carotid intimal medial thickness (CIMT) as well carotid plaque as their respective predictive value for adverse cardiovascular event.
- Data from prospective studies with at least 1000 participant in each study was pooled to describe the relationship of CIMT (9 studies) as well of carotid plaque (9 studies) and risk for cardiovascular disease events in individuals without known cardiovascular disease.
Results:
- The consensus statement recommended that “CIMT measurements should be limited to the far wall of the common carotid artery and should be supplemented by a thorough scan of the extracranial carotid arteries for the presence of carotid plaque, to increase sensitivity for identifying subclinical vascular disease.”
- In addition the expert recommend that “Carotid plaque is defined as the presence of focal wall thickening that is at least 50% greater than that of the surrounding vessel wall or as a focal region with CIMT greater than 1.5 mm that protrudes into the lumen that is distinct from the adjacent boundary.”
- The literature provided evidence that the adjusted relative risks associated with the greatest degrees of CIMT as were at least 2 fold higher in most studies and thus would may potentially result in improved clinical risk prediction in appropriately selected patients.
- In similar fashion, the presence of carotid plaque was found associated with a hazard ratio of 1.8-4.2 for prediction of CVD events.
- The consensus statement major recommendations are as follows:
o CIMT and identifying carotid plaque by ultrasound are most useful for refining CVD risk assessment in patients at intermediate CVD risk (FRS 6%-20% without established CHD, peripheral arterial disease, cerebrovascular disease, diabetes mellitus, or abdominal aortic aneurysm).
o Imaging should not be performed in patients with established atherosclerotic vascular disease or if the results would not be expected to alter therapy.o Serial studies of CIMT to address progression or regression are not recommended for use in clinical practice.
SHAPE Perspective:
- This is a timely publication describing the clinical value of utilization simple non-invasive carotid ultrasound in primary CHD prevention strategies.
- These recommendations are similar with current consensus statement recognizing the value of coronary artery calcification scores (CACS) in risk stratifying vulnerable individuals and identifying the need for aggressive medical management.
- These publications and emerging guidelines are consistent with SHAPE guidelines published in 2006 which advocated use of CACS and CIMT for risk stratification in appropriate population to reduce the overall societal CHD burden.
1) SHAPE Guideline in Circ.
2) Dinner Symposium at ACC!
3) Research highlights
of March 2008
4) Featured study including
SHAPE Perspectives
Featured Links:
· SHAPE Guideline
· Downloads
· PowerPoint Library
· Newsletter Archive
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