The First SHAPE (Screening for Heart Attack Prevention and Education) Guideline

Atherosclerotic cardiovascular disease (A-CVD) is preventable. Major causal risk factors are known, and effective and safe treatments exist. However, A-CVD remains the leading cause of death and severe disability not only in affluent countries, but also globally. The burden of A-CVD is growing faster in poor and developing countries threatening their future economic development. Traditional methods for prevention of A-CVD have proven largely insufficient. Although many societal factors contribute to the epidemic of A-CVD (eg, smoking, obesity, diabetes, insufficient physical activity, and so on) and deserve renewed attention, early detection of the asymptomatic vulnerable patient who has significant subclinical atherosclerosis presents as a low hanging fruit in primary prevention of A-CVD. The Screening for Heart Attack Prevention and Education (SHAPE) Task Force, comprised of an international group of experts, has proposed the First SHAPE Guideline to address a major shortcoming in the existing guidelines in primary prevention of A-CVD. It is based on the observation that most heart attacks and strokes occur in people who are not classified as high risk by the traditional risk factor-based approach recommended in the United States (Framingham Risk Score) and Europe (SCORE). Unfortunately, these guidelines provide inadequate warning to asymptomatic individuals with subclinical atherosclerosis who are unaware of their high-risk status and are not aggressively treated by their physicians who follow the existing recommendations. Consequently, most of these asymptomatic individuals, who are vulnerable to a near-future heart attack, are not offered the benefit of existing prophylactic therapies. Unlike decades ago when screening for risk factors of A-CVD was the only available risk stratification method in primary prevention, today, noninvasive detection of atherosclerosis is feasible and widely available. It provides a direct and individualized method for risk assessment. A large body of evidence has been compiled in recent years showing the superior prognostic value of detecting atherosclerosis rather than risk factors of atherosclerosis. The First SHAPE Guideline calls for noninvasive screening of all asymptomatic men 45 to 75 years old and asymptomatic women 55 to 75 years old (except those defined as very low risk) to detect and treat individuals with subclinical atherosclerosis. The intensity of treatment should correlate with the severity of the disease. Among existing tools for detection of subclinical atherosclerosis, the SHAPE Task Force has created the SHAPE Flow Chart based on the following 2 noninvasive imaging techniques: coronary artery calcium scoring using computed tomography and carotid intima media thickness and plaque using B-mode ultrasonography.