SHAPE Statement Reacting to ACCF/AHA Guidelines on Cardiovascular Risk Assessment in Asymptomatic Adults
CHICAGO, November 17, 2010 – SHAPE, The Society for Heart Attack Prevention and Eradication (http://www.shapesociety.org) ,a nonprofit organization that promotes early detection and preventive intervention to reduce heart attack risk, today issued a statement regarding the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines’ release of “2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults.” The guideline was released online this week and will be published in the December 14/21, 2010 edition of the Journal of the American College of Cardiology.
The following should be attributed to Dr. PK Shah, chairman of the SHAPE Scientific Board and director, Division of Cardiology at Cedars-Sinai Heart Institute and Medical Center in Los Angeles:
After nearly a decade of work to encourage the widespread adoption of atherosclerosis tests for a subset of apparently healthy people who unknowingly have hidden heart disease (The SHAPE Guidelines published in the American Journal of Cardiology in 2006), we welcome these new practice guidelines and believe they represent a breakthrough. For the first time, the ACCF/AHA Task Force on Practice Guidelines has acknowledged the value of coronary artery calcium scoring (CACS) and carotid artery intima-media thickness (CIMT) scanning by ultrasound for cardiovascular risk assessment in subsets of asymptomatic subjects.
We hope these new practice guidelines will provide the peace-of-mind physicians need to encourage intermediate risk patients to undergo CACS or CIMT scanning. Of course, other obstacles to widespread testing remain, including insurance reimbursement for the tests. We expect the growing consensus of the efficacy of these atherosclerosis tests will significantly advance efforts to expand reimbursement so all patients who can benefit from the tests have access to them.
Our enthusiasm about this victory is tempered by the ACCF/AHA Task Force stopping short of an outright recommendation of the two atherosclerosis tests recommended by SHAPE. We believe the evidence is sufficient to recommend CACS or CIMT scanning for risk assessment of men 45-80 years of age and women 55-80 years of age who have a Framingham Risk Score of 6% or greater. By stating that a test “is reasonable,” the ACCF/AHA Task Force has removed doubt about the tests, but the absence of a stronger Class 1 recommendation may create uncertainty. SHAPE believes that the tests should be recommended. The updated SHAPE II Guidelines provide a simple and sensible approach to implement these tests in clinical practice.
However, the new ACC/AHA Guidelines are a giant leap from the skepticism and outright opposition expressed in the past. Physicians who advise their asymptomatic intermediate risk patients to undergo the tests are no longer at odds with the major practice guidelines.
We applaud the ACCF/AHA Task Force for carefully examining the advances in research and practice that clearly illustrate the effectiveness of CACS and CIMT scanning for assessing an individual’s cardiovascular risk. We will be forever grateful to the research teams and their sponsors who enabled this enormous advance in heart attack risk detection, including the Atherosclerosis Risk in Communities Study (ARIC) and the Multi-Ethnic Study of Atherosclerosis (MESA), sponsored by the National Heart, Lung and Blood Institute (NHLBI) of the National Institutes of Health, and the Heinz Nixdorf Recall Study, funded by the Heinz Nixdorf Foundation and the German Foundation of Research.