SHAPE Task Force Calls for Changing National Cholesterol Education Program (NCEP) to National Atherosclerosis Education Program

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SHAPE Urges NIH to Adopt Personalized Medicine for Heart Attack Prevention

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:

Arthur Agatston, M.D.
Associate Professor of Medicine,
University of Miami Miller School of Medicine
Founder and Director of the South Beach Diet and Heart Health Program
Miami, FL

Michael Blaha, M.D.
The Johns Hopkins
Ciccarone Center for the Prevention of Heart Disease
Baltimore, MD

Daniel S. Berman, M.D.
Director of Cardiac Imaging and of Nuclear
Cardiology at Cedars-Sinai
Los Angeles, CA

Matthew Budoff, M.D.
Vice President, Society of Atherosclerosis Imaging,
Professor of Medicine and Director of Preventive
Cardiology, UCLA Harbor
Los Angeles, CA

Michael H. Davidson, M.D.
FNLA Professor, Director of Preventive Cardiology, The University of Chicago Pritzker School of Medicine, Executive Medical Director,
Radiant Research
Chicago, IL

James Ehrlich, M.D.
Clinical Associate Professor
University of Colorado
Denver, CO

Raimund Erbel, M.D.
Professor of Medicine
University of Duisburg-Essen
Director of Department of Cardiology
West German Heart Center
Essen, Germany

Erling Falk, M.D., Ph.D.
Chief of SHAPE Guidelines Editorial Committee
Professor of Pathology and Cardiology
Aarhus University Hospital (Skejby)
Aarhus, Denmark

Steven B. Feinstein, M.D.
Professor of Medicine and Director of Echocardiograpy
Division of Cardiology, Rush University Medical Center
Chicago, IL

Harvey S. Hecht, M.D.
Professor of Medicine
Associate Director of Cardiac Imaging
The Mount Sinai Medical Center
New York, NY

Howard Hodis, M.D.
Professor of Cardiology and Preventive Medicine
Professor for Molecular Pharmacology and Toxicology
Director of Atherosclerosis Research Unit at the Division of Cardiovascular Medicine
Keck School of Medicine University of Southern California
Los Angeles, CA

Sanjay Kaul, M.D., M.P.H.
Director, Cardiology Fellowship Training Program
Director, Vascular Physiology and Thrombosis Research
Laboratory at the Burns and Allen Research Institute
Cedars-Sinai Medical Center
Los Angeles, CA

Iftikhar J. Kullo, M.D.
Professor of Medicine
Division of Cardiovascular Disease
College of Medicine
Mayo Clinic
Rochester, MN

Roxana Mehran, M.D.
Professor of Medicine and Director of Interventional Cardiovascular Research and Clinical Trials, Mount Sinai Heart, the Zena and Michael A. Wiener Cardiovascular Institute
Mount Sinai School of Medicine
New York, NY

Morteza Naghavi, M.D.
Founding President of SHAPE
CEO of Fairway Medical Technologies, Inc.
Houston, TX

Tasneem Z Naqvi, M.D.
Professor of Medicine & Clinical Scholar
Director of Non Invasive Diagnostic Services
Keck School of Medicine
University of Southern California
Los Angeles, CA

Paolo Raggi, M.D.
Academic Director, Mazankowski Alberta Heart Institute
University of Alberta
Edmonton, AB

PK Shah, M.D.
Chairman of SHAPE Scientific Committee
Chief of Cardiology and Director of Atherosclerosis Research, Cedars Sinai Medical Center
Professor of Medicine at UCLA School of Medicine
Los Angeles, CA

Henrik Sillesen, M.D., D.MSc.
Director of HRP Study Carotid Examinations
Chairman, Department of Vascular Surgery Rigshospitalet
Professor of Surgery, University of Copenhagen
Copenhagen, Denmark

J. David Spence, M.D.
Professor of Neurology and Clinical Pharmacology,
University of Western Ontario
Director of Stroke Prevention & Atherosclerosis Research Centre,
Robarts Research Institute
London, ON

Khurram Nasir, M.D.
Section of Cardiovascular Medicine,
Yale School of Medicine,
New Haven, CT

H. Robert Superko, M.D.
Chief of Medical Affairs – Celera
Adjunct Professor
Mercer University School of Pharmaceutical Sciences
Atlanta, GA

Pierre-Jean Touboul, M.D.
Professor of Neurology
Department of Neurology and Stroke Center
AP-HP Bichat University Hospital
Neurology and Stroke Center
Paris, France

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
Baltimore, MA

About the Society for Heart Attack Prevention and Eradication (SHAPE):
The mission of SHAPE ( ) is to eradicate heart attack by championing new strategies for prevention while advancing the scientific quest for a cure. The focus of SHAPE is on the asymptomatic “vulnerable patients” who are unaware of their hidden cardiovascular risk. SHAPE believes the status quo leaves the Vulnerable Patient unprotected hence it is unacceptable and must change. In addition to the detection of risk factors of atherosclerosis, healthcare professionals must pay attention to atherosclerosis itself. Individuals without alarming risk factors but with hidden plaque (asymptomatic atherosclerosis) must be treated and alerted to their high risk. Through educational programs presented to both medical professionals and the community, SHAPE raises awareness of the primary prevention of atherosclerotic cardiovascular disease. The vision of SHAPE is a world free from heart attack.

For additional information, contact:
Jay Donnella
Executive Director
713-529-4484 or 877-SHAPE11 (877-742-7311)
Email: info(at)shapesociety(dot)org

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