SHAPE Task Force Calls for Changing National Cholesterol Education Program
(NCEP) to National Atherosclerosis Education Program
SHAPE Urges NIH to Adopt Personalized Medicine for Heart Attack Prevention
HOUSTON, March 17, 2012 –
When the NIH launched NCEP in 1985, the focus was on the detection and treatment of high cholesterol, largely in isolation from other cardiovascular risk factors. Since then, numerous discoveries and new research in the field of cardiovascular risk prediction have enabled earlier detection of risk and the identification of those who stand to benefit most from cholesterol-lowering therapies.
One of the most important developments is the use of noninvasive imaging to diagnose atherosclerosis in its pre-symptomatic stage. While detection and treatment of traditional risk factors such as high cholesterol and high blood pressure are important, it is now clear that the direct measurement of atherosclerosis, which enables personalized risk assessment, is useful in identifying high risk individuals and improves risk classification.
In fact, in the 9 years since the NIH released NCEP-III Guidelines which introduced “Global Risk Assessment”, subclinical atherosclerosis has gained increased recognition as a more powerful predictor than all risk factor combinations and risk factor-based scoring systems. The burden of atherosclerotic plaques predicts adverse events much more accurately than risk factors, particularly near-term events.
Consequently, in 2009, the Appropriate Use Criteria considered coronary artery calcium scans (CAC) “appropriate” for asymptomatic patients with an “Intermediate” global risk estimate, as well as those deemed lower risk with a family history of premature coronary heart disease. In 2010, the ACC/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults followed suit, elevating CAC and carotid plaque and intima-media thickness (CIMT) to Class IIa recommendations for cardiovascular risk assessment in asymptomatic adults at intermediate (10% to 20% 10-year) risk.
As we await the NCEP IV Guidelines, the SHAPE Task Force anticipates that the discoveries of the past decade will be incorporated in the NCEP Adult Treatment Panel (ATP) IV, and that the NIH will assign a major role to detection of subclinical atherosclerosis to improve risk prediction for primary prevention of atherosclerotic cardiovascular disease.
The Guidelines should no longer favor intensive treatment of cholesterol independent of atherosclerosis, but instead must target those individuals with the highest burden of atherosclerotic CVD risk who are expected to benefit the most from aggressive cholesterol-lowering therapies. The heightened awareness of possible statin induced hyperglycemia (diabetes mellitus) and rare cognitive dysfunction reinforces the need for more accurate risk assessment to insure that widespread drug therapy is appropriately implemented.
The SHAPE Task Force therefore suggests changing the name of the National Cholesterol Education Program to the National Atherosclerosis Education Program. This change will appropriately shift the focus from a single risk factor of atherosclerosis (cholesterol) to atherosclerosis itself, and can help save the lives of many High Risk individuals, who are currently misclassified as Low or Intermediate Risk.
SHAPE is continuing its scientific quest for innovative approaches to heart attack prevention, and ultimately, eradication. As an educational nonprofit organization, SHAPE advocates only the most scientifically proven approach, independent of specific practices or procedures. SHAPE is actively supporting the Department of Health & Human Services Million Hearts™ initiative to prevent one million heart attacks and strokes over five years.
Members of the SHAPE Task Force include:
SHAPE Distinguished Advisors:-
|Valentine Fuster, M.D., Ph.D.|
Director of Mount Sinai Heart, the Zena and Michael
A. Wiener Cardiovascular Institute and the
Marie-Josee and Henry R. Kravis Center for Cardiovascular Health
Mount Sinai Medical Center
Professor, Richard Gorlin, MD and Heart Research Foundation
Mount Sinai School of Medicine
New York, NY
|Rodger S. Blumenthal, M.D.|
Professor of Medicine and Director,
The Johns Hopkins Ciccarone Center for the Prevention
of Heart Disease, Division of Cardiology,
Johns Hopkins University