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News / Headlines
Contact: Daniel Keeney, APR
DPK Public Relations
832.467.2904
dan@dpkpr.com
AHA’s New Guidelines on CVD Prevention in Women Can Result in
Massive Overtreatment
and Undue “High Risk” Labeling of Many Healthy Women
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HOUSTON,
February 22, 2011 – The 2011 guidelines from the American
Heart Association for the prevention of cardiovascular disease (CVD)
in women1 have raised serious issues that should be promptly
addressed. The previous 2004 and 2007 guidelines used the definition
of High Risk based on hard coronary heart disease (CHD) endpoints,
i.e., 10-year risk of myocardial infarction or coronary death 20%.
The 2011 updated guideline lowers this threshold to 10% and,
furthermore, changes the endpoint from "hard CHD" to the much more
common endpoint "all CVD," including hard CHD, coronary
insufficiency, angina, stroke, transient ischemic attack, heart
failure and claudication.
The SHAPE Task Force welcomes the much needed update of existing
guidelines for risk assessment of asymptomatic at-risk individuals.
However, we have serious concerns about the new AHA women’s
guideline1 since an arbitrary change in the definition of High Risk
is likely to result in massive overtreatment and undue “High Risk”
labeling of many otherwise healthy women. For example, a 65 year
old non-smoking, non-diabetic, non-hypertensive woman with total
cholesterol of 200 mg/dl and HDL of 49 mg/dl who lives an active
life style would now be classified as High Risk. In contrast,
the same individual would be defined as Low Risk by the 2010 ACCF/AHA2
and NCEP Guidelines. More importantly, the new guidelines do not
take into account the fact that such an individual’s risk could be
better refined by screening for subclinical atherosclerosis.
SHAPE recommends that the new AHA women’s guideline1 be
amended to prevent undesired consequences. To improve individual
risk assessment in this population, the guideline should include
noninvasive detection of subclinical atherosclerosis, through
coronary artery calcium scoring or measurement of carotid plaque and
intima-media thickness (IMT). Such an amendment would be in line
with the 2010 ACCF/AHA guidelines (for assessment of cardiovascular
risk in asymptomatic adults) in which testing for subclinical
atherosclerosis (coronary artery calcium scoring and carotid plaque/IMT)
received a strong evidence based (level IIa) recommendation.2,3
The new AHA women’s guideline criticizes the absence of outcome
studies for risk assessment based on testing for subclinical
atherosclerosis. However, it fails to acknowledge that the approach
for risk assessment which uses Framingham Risk Score and NCEP
guidelines has also never been demonstrated improve outcomes in
clinical trials.
In conclusion, given the large, consistent and growing body of
evidence showing that testing for subclinical atherosclerosis is a
more accurate method of predicting atherosclerotic cardiovascular
events than testing only for traditional risk factors of
atherosclerosis, the SHAPE Task Force respectfully urges the
responsible authorities at the American Heart Association to address
the following question:
Is it reasonable, cost-effective and ethically acceptable to
arbitrarily label millions of women as being “High Risk” for
atherosclerotic cardiovascular events without testing them for
subclinical atherosclerosis?
SHAPE TASK Force
Society for Heart Attack Prevention and Eradication (SHAPE)
Houston, Texas, USA
References:
1- Mosca L, Benjamin EJ, Berra K, Bezanson JL, Dolor RJ, Lloyd-Jones
DM, Newby LK, Piņa IL, Roger VL, Shaw LJ, Zhao D, Beckie TM,
Bushnell C, D'Armiento J, Kris-Etherton PM, Fang J, Ganiats TG,
Gomes AS, Gracia CR, Haan CK, Jackson EA, Judelson DR, Kelepouris E,
Lavie CJ, Moore A, Nussmeier NA, Ofili E, Oparil S, Ouyang P, Pinn
VW, Sherif K, Smith SC Jr, Sopko G, Chandra-Strobos N, Urbina EM,
Vaccarino V, Wenger NK. Effectiveness-Based Guidelines for the
Prevention of Cardiovascular Disease in Women--2011 Update: A
Guideline from the American Heart Association. Circulation. 2011 Feb
16.
2- Greenland P, Alpert JS, Beller GA, Benjamin EJ, Budoff MJ, Fayad
ZA, et al. 2010 ACCF/AHA Guideline for assessment of cardiovascular
risk in asymptomatic adults. A report of the American College of
Cardiology Foundation/American Heart Association Task Force on
Practice Guidelines. J Am Coll Cardiol 2010;56:e50–103.
3- Taylor AJ, Cerqueira M, Hodgson JM, Mark D, Min J, O'Gara P,
Rubin GD, Kramer CM, Taylor AJ, Berman D, Brown A, Chaudhry FA, Cury
RC, Desai MY, Einstein AJ, Gomes AS, Harrington R, Hoffmann U, Khare
R, Lesser J, McGann C, Rosenberg A, Schwartz R, Shelton M, Smetana
GW, Smith SC Jr, Wolk MJ, Allen JM, Bailey S, Douglas PS, Hendel RC,
Kramer CM, Min J, Patel MR, Shaw L, Stainback RF. ACCF/SCCT/ACR/AHA/ASE/ASNC/SCAI/SCMR
2010 Appropriate Use Criteria for Cardiac Computed Tomography. J Am
Coll Cardiol 2010; 56: 1864 – 94.
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About SHAPE
Based in Houston, 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 hidden heart attack risk. 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 Web site at
www.shapesociety.org.
About the SHAPE Task Force
The SHAPE Task Force is a group of world-renowned cardiovascular
specialists who have agreed to participate in SHAPE’s initiative to
provide their expertise to help develop a screening guideline for
detection and treatment of healthy individuals who have no sign or
symptom of heart disease but have hidden plaques and thereby are at
risk of a near future heart attack and stroke.
SHAPE Task Force Members:
Daniel S. Berman, M.D., Matthew J. Budoff, M.D., Michael H.
Davidson, M.D., Jim Ehrlich, M.D., Raimund Erbel, M.D., Erling Falk,
M.D., Ph.D., Steven B. Feinstein, M.D., Jeffrey Fine, Ph.D., Kirk
Geter, D.P.M., Craig Hartley, Ph.D., Harvey S. Hecht, M.D., Howard
Hodis, M.D., Sanjay Kaul, M.D., M.P.H., Iftikhar J. Kullo, M.D.,
Daniel Lane, M.D., Ph.D., Marge Lovell, R.N., Ralph Metcalfe, Ph.D.,
Tasneem Z. Naqvi, M.D., Morteza Naghavi, M.D., Paolo Raggi, M.D.,
George P. Rodgers, M.D., PK Shah, M.D., David Spence, M.D., H.
Robert Superko, M.D., Henrik Sillesen, M.D., Ph.D., Pierre-Jean
Touboul, M.D.
SHAPE Task Force Advisors:
Valentin Fuster, M.D., Roger Blumenthal, M.D., Ph.D., Leslee Shaw,
Ph.D.
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