Estimated risk/benefit of aspirin in primary prevention by coronary artery calcium score in MESA participants.

 

* CHD and CVD risk based on the Framingham Risk Score.

 

**Red lines represents estimated 5-year number needed to harm estimations based on a 0.23% increase in major bleeding over 5 years.

 

*** Five-year number needed to treat estimations based on a 32% relative reduction in CHD events for men and a 17% relative reduction in CVD events for women.

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4412344/ 

 

Over the past 12 months new large studies reported that the small benefit of aspirin for prevention of heart attack in people without any history of heart disease may not exceed the small risk of serious bleeding. They concluded in moderate-risk patients, aspirin use needs to be individualized, weighing the risk of having a heart attack or stroke against the risk of bleeding.

 

https://www.acc.org/latest-in-cardiology/clinical-trials/2018/08/25/01/46/arrive

 

https://www.acc.org/latest-in-cardiology/clinical-trials/2018/08/25/02/16/ascend-aspirin

 

https://www.nejm.org/doi/full/10.1056/NEJMoa1210384

 

 The above studies further shed light on the importance of SHAPE guidelines for personalizing cardiovascular risk assessment.

 

 “We urge hospitals, physicians and all primary care providers to adopt personalized medicine for prevention of heart attacks. When it comes to aspirin and many other drugs, one size does not fit all,” said Dr. Morteza Naghavi, M.D., President of American Heart Technologies and founder of SHAPE. “Hospitals do not need new diagnostic technologies to offer coronary calcium scoring, almost all of them have access to a CT scanner, which is all they need.”

 

The new guideline issued by AHA and ACC support the SHAPE Task Force’s longstanding position that coronary artery calcium (CAC) scoring is useful for establishing a person’s risk for heart attack and stroke. 

 

“Now that the new ACC/AHA guideline acknowledges a significant role for Coronary Artery Calcium, we need everyone’s help to obtain national coverage for the test just like SHAPE did in Texas helping HB1290 pass,” said JoAnne Zawitoski, a distinguished maritime attorney in Baltimore DC area and the volunteer chairwoman of SHAPE. “If insurance companies do not pay for the test, physicians will find it difficult to adopt the new guidelines, and patients will be underserved.”     

 

Previously several leading cardiologists who are volunteer advisors of SHAPE commented on the new ACC/AHA guidelines. 

 

“It is great that coronary calcium scoring moved up in the new guideline. There is still room for improvement, but definite progress.” said Dr. David Maron, Clinical Professor of Medicine and Director of Preventive Cardiology at Stanford University School of Medicine in Palo Alto and member of the SHAPE Scientific Advisory Board.

 

“The American Heart Association and American College of Cardiology represent the best of the best in the fight against heart disease. We knew it was just a matter of time for them to recognize the importance of coronary calcium which is the initial step in SHAPE Guidelines,” said Dr. PK Shah, Professor of Cardiology at UCLA and Chair of Scientific Committee for the SHAPE Task Force. “Despite this delightful news, until the reimbursement and public education barriers are removed, preventive cardiology will be far from personalized preventive care.” 

 

Many practicing physicians are still unaware of the value of coronary calcium scoring and have not yet incorporated it into their practice.  Now that AHA and ACC have recognized the value of measuring CAC, the challenge is public education both for patients and physicians. 

 

“Unfortunately, the status-quo for prevention of heart attack was based on an individual’s “risk factors” rather on the amount of disease in his or her coronary arteries. Preventive therapies are profoundly effective—we just need to know who needs them. SHAPE has long advocated going beyond traditional risk factors, to measure CAC for personalized risk assessment. It is gratifying to see the SHAPE approach is vindicated,” said Dr. Daniel Berman, Professor of Imaging and Medicine and Director of Cardiac Imaging at Cedars-Sinai Medical Center, on behalf of the SHAPE Task Force. 

 

It has taken over a decade for CAC imaging to be acknowledged as useful in early detection and treatment decisions about atherosclerotic cardiovascular disease prevention. Now that this major step forward is taken, the next challenge is securing reimbursement and universal coverage by payers. The good news is that the cost of coronary calcium scoring has decreased significantly from what it was over a decade ago. Today, in the majority of diagnostic centers, a CAC tests can be done at $100-$200. Some hospitals offer it for $75.

 

It is noteworthy that all of SHAPE doctors and board members are unpaid volunteers and have contributed an enormous amount of their time and personal resources for the good cause of the organization.

 

About SHAPE
The Society for Heart Attack Prevention and Eradication (SHAPE) is a non-profit organization that promotes education and research related to prevention, detection, and treatment of heart attacks. SHAPE is committed to raising public awareness about revolutionary discoveries that are opening exciting avenues to prevent heart attacks. SHAPE’s mission is to eradicate heart attacks in the 21st century. Additional information is available on the organization’s website at http://shapesociety.org or by calling 1-877-SHAPE11.

 

About The “Vulnerable Patient”:
Although coronary artery calcium is the best indicator studied and available today for detection of the vulnerable patient, because it measures the total burden of coronary atherosclerosis, the SHAPE Task Force recognizes that existing tools, including coronary calcium scoring, fall short in accurately identifying the Vulnerable Patient. Most recently, SHAPE has proposed a major, multi-national collaborative project dubbed “Machine Learning Vulnerable Patient”. This project aims at utilizing certain forms of artificial intelligence in a unique subset of cases from various prospective “cohort studies” around the world to identify the biological signature of a near future heart attack.  A “cohort study” is one in which one or more samples are followed prospectively and subsequent status evaluations are made with respect to a disease or outcome in order to determine which initial participants’ risk factors are associated with the disease or outcome.  Through this SHAPE initiative, blood samples will be collected from blood banks of major cohorts in which apparently healthy people experienced a heart attack few days, weeks, or months after their blood draw and clinical exams. The in-depth investigation of this unique subset has the potential to provide researchers with new insight into what is happening in the days, weeks, and months prior to a heart attack, and will allow them to characterize related biological signals. Once the vulnerable patient is characterized, researchers will be able to conduct clinical trials to evaluate the effect of various therapeutic interventions on these individuals and develop new “short-range” treatment guidelines that do not exist today. Currently, heart attacks are predicted using a 10-year risk prediction based on “risk factors” alone.  Imagine if we tried to predict ten years ago where and when Hurricanes Harvey and Irma would strike: our predictions would hardly be accurate.  We know long term predictions of disasters in nature are ineffective, because they do not trigger immediate or urgent preventive actions. For this same reason, preventive cardiology needs a more accurate short-term predictor (an accurate 12 month forecast) of who is likely to have a heart attack, so that more lives can be saved.