Vulnerable patients are between a 'ROC and a hard place': Yes, it's time to screen for coronary artery disease

Cleveland Clinic Journal of Medicine,1 Dr. Michael Lauer argued for retaining the status quo and rejecting the recently proposed Screening for Heart Attack Prevention and Education (SHAPE) guidelines.2 As authors of the SHAPE guidelines, we would like to address his arguments.

■ SCREENING FOR DISEASE RATHER THAN RISK FACTORS

Atherosclerotic cardiovascular disease is still the leading cause of death and morbidity in the United States and is achieving similar status in the rest of the world.3 Traditional strategies for primary prevention based on detecting risk factors are inadequate, because an individual patient’s risk factors may not tell us if disease is truly present or how severe it is.

The Association for Eradication of Heart Attack proposed the SHAPE guidelines on the basis of consensus among an international group of experts.2 After reviewing all available evidence, the group recommended that all asymptomatic men 45 to 75 years of age and women 55 to 75 years of age (except for those at very low risk) undergo noninvasive screening for subclinical atherosclerosis, with the goals of treatment to be determined by the amount of subclinical atherosclerosis detected, rather than by risk factors.

■ REBUTTING THE ARGUMENTS AGAINST THE SHAPE GUIDELINES

Dr. Lauer presents two main arguments against adopting the SHAPE guidelines: lack of evidence and conflicts of interest ...

To read full article, click here: www.ccjm.org/PDFFILES/Naghavi10_07.pdf

To read Dr. Lauer's article, click here: http://www.ccjm.org/PDFFILES/Lauer9_07.pdf