Texas Legislature to Hear Heart Attack Preventive Screening Bill on March 10, 2009

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The first legislative effort to combat the number one killer could prevent 4,300 sudden cardiac deaths and save $1.6 billion per year in Texas.

It is about time that we cover preventive screening for the number one killer in Texas, and take action to reduce healthcare costs through preventive healthcare

Two years ago, Texas Representative Rene Oliveira, supported by Houston-based Society for Heart Attack Prevention and Eradication (SHAPE) shapesociety.org, introduced a bill in the Texas Legislature that would require insurance companies to pay for heart attack preventive screening test. The bill, which was turned down by the insurance committee then, is called up to an immediate hearing on March 10.

"We are delighted to hear that Texas legislature surprisingly requested an immediate hearing on the bill," said Dr. Morteza Naghavi, founder of SHAPE and Chairman of the SHAPE Task Force who is invited to testify at the Texas house of representative. "This is truly groundbreaking landmark legislation, much like the legislation for mammography," said Dr. Naghavi.

On Tuesday, March 10, 2009, Rep. Oliveira's Texas Heart Attack Prevention Bill (identical to last session's proposal) will be heard in the House Insurance Committee. The bill is the first legislative effort in the United States to mandate the careful and responsible implementation of a comprehensive heart attack risk assessment and reduction strategy. It closely follows the SHAPE Guideline for identification of apparently healthy individuals who have a high risk of a near future heart attack but are unaware of their risk. The guideline was developed by the SHAPE Task Force, an international contingent of leading cardiovascular physicians and researchers.

Almost all heart attacks are preceded by atherosclerosis (plaque buildup in the arteries). Despite the availability of non-invasive imaging tests that can detect the presence of atherosclerosis and measure its severity, many physicians continue to rely solely upon screening for traditional risk factors of atherosclerosis.

"Assessment of heart attack risk on the basis of traditional risk factors alone such as high cholesterol and high blood pressure and so forth, while useful, misses many who are at high risk and also incorrectly flags some for high risk who are in fact at very low risk of near term heart attack; on the other hand detection of atherosclerosis by non-invasive imaging, as suggested by the SHAPE group, accurately identifies plaque and improves the ability to identify at-risk individuals who could benefit from aggressive preventive intervention while sparing low-risk subjects from unnecessary aggressive medical therapy," said Dr. P.K. Shah, Director of Cardiology at Cedars Sinai Heart Institute in Los Angeles, a leading member of the SHAPE Task Force who is also an active member of the American Heart Association. "Sadly, these vulnerable patients go undetected until struck by a heart attack, because insurance companies don't cover the newer heart attack screening imaging tests."

Rep. Oliveira discovered this problem when his insurer initially refused to cover the heart scan that discovered plaque buildup and prompted a heart bypass operation.

"It is about time that we cover preventive screening for the number one killer in Texas, and take action to reduce healthcare costs through preventive healthcare," said Representative Oliveira, a Democrat from Brownsville, Texas. "Right now, we are extending the lives of those who can afford the procedure while hundreds of thousands of Texans with hidden heart disease go undetected because of antiquated thinking. The time has come for this change."

Rep. Oliveira's bill would apply to men between ages 45 and 75, and women between ages 55 and 75, who are at intermediate risk of a heart attack according to their Framingham Risk Score. The bill would require reimbursement for two types of procedures: 1) the measurement of coronary artery calcium score (CACS) by CT and 2) the measurement of carotid intima-media thickness (CIMT) and plaque by ultrasonography. These two tests have proven to be strong predictors of those who are vulnerable to a heart attack or stroke.

"At one time, imaging technologies to look inside the body and screen for cancer seemed like an impractical idea, but after reimbursement approval they have become part of everyday medicine and have saved countless lives," said Dr. Daniel Berman, Chief of Cardiovascular Imaging at Cedars Sinai Medical Center in Los Angeles and Professor of Medicine at UCLA who is also a member of the SHAPE Task Force. "If this legislation passes, we anticipate that tens of thousands of people who are completely unaware of their severe but silent heart disease can be detected and saved from a catastrophic heart attack by getting into intensive treatment."

Heart attack and stroke account for more death and disability than all cancers combined. Unlike cancers, heart attack strikes more than half of its victims by sudden death, leaving no opportunity for treatment. In fact, the rates of unexpected heart attack and out-of-hospital sudden cardiac death have remained at high levels for the past 30 years. Multiple screening tests are approved for asymptomatic cancers such as mammography and colonoscopy. However, none is approved for asymptomatic atherosclerosis, which underlies both heart attack and stroke. This void leaves many individuals - even those with severe atherosclerosis - totally unaware of their risk because they have no symptoms.

An analysis by the SHAPE Task Force estimates that proper screening of these asymptomatic men and women could have the following outcomes:

  • Prevent more than 4,300 deaths from cardiovascular disease each year in Texas (over 90,000 deaths in the U.S.).
  • Reduce the Texas population with a history of heart attack - currently estimated to be 550,000 - by as much as 25 percent.
  • Save approximately $1.6 billion annually (over 21 billion in the U.S.).

"We are very thankful for Representative Oliveira's strong leadership in working to correct a profound failure of our healthcare system," said Dr. Matthew Budoff, a member of the SHAPE Task Force who is the leading author of the latest scientific statement of American Heart Association regarding noninvasive cardiac CT imaging. "These technologies are widely available, but because insurance doesn't cover them, only people with the means to pay for the procedures out of their own pockets can benefit from these advances. If passed, this bill will have a monumental impact on preventive cardiovascular healthcare that can go far beyond Texas."

Atherosclerosis, a metabolic and inflammatory disease that causes plaque build up in arteries, is responsible for nearly all cases of heart attack and most cases of strokes. Individuals with the highest degree of atherosclerotic plaque burden are described as "the Vulnerable Patient." Such individuals exhibit no signs of heart disease and are not identified as very-high-risk by traditional risk factor assessment. Representative Oliveira's bill is designed to identify this population and get them the treatment needed to extend their lives.

About SHAPE:
Originated from the Texas Medical Center in Houston, the Society for Heart Attack Prevention and Eradication (SHAPE) is a non-profit organization founded by Dr. Morteza Naghavi, a former faculty of the Texas Heart Institute and the University of Texas in Houston. The mission of SHAPE is to promote education and research related to mechanism, prevention, detection, and treatment of heart attacks. The organization is committed to raising public awareness about recent revolutionary discoveries that opened exciting new avenues to prevent heart attack. The SHAPE's mission is to eradicate heart attacks in the 21st century. Additional information is available on the organization's Web site at http://www.shapesociety.org or call 1-877-SHAPE11.

About SHAPE Task Force :
Chairman: Morteza Naghavi, M.D. Editorial Committee: Prediman K. Shah, M.D. (Chief); (alphabetic order): Raymond Bahr, M.D., Daniel Berman, M.D., Roger Blumenthal, M.D., Matthew J. Budoff, M.D., Jay Cohn, M.D., Erling Falk, M.D., Ph.D., Ole Faergeman, M.D., Zahi Fayad, Ph.D., Harvey S. Hecht, M.D., Wolfgang Koenig, M.D., Ph.D., Daniel Lane, M.D., Ph.D., Morteza Naghavi, M.D., John Rumberger, M.D., Ph.D., Allen J. Taylor, M.D. Writing Group: Erling Falk, M.D., Ph.D. (Coordinator); (alphabetic order): Juhani Airaksinen, M.D., Dan Arking, Ph.D., Juan Badimon, Ph.D., Raymond Bahr, M.D., Daniel Berman, M.D., Matthew J. Budoff, M.D., Jay Cohn, M.D., Jasenka Demirovic, M.D., Ph.D., George A. Diamond, M.D., Pamela Douglas, M.D., Ole Faergeman, M.D., Zahi Fayad, Ph.D., James A. Goldstein, M.D., Harvey S. Hecht, M.D., Victoria L.M. Herrera, M.D., Sanjay Kaul, M.D., M.P.H., Wolfgang Koenig, M.D., Ph.D., Robert A. Mendes, M.D., Morteza Naghavi, M.D.; Tasneem Z. Naqvi, M.D., Ward A. Riley, Ph.D., Yoram Rudy, PhD, John Rumberger, M.D., Ph.D., Leslee Shaw, Ph.D., Robert S. Schwartz, M.D., Arturo G. Touchard, M.D. Advisors (alphabetic order): Arthur Agagston, M.D., Stephane Carlier, M.D., Ph.D., Raimund Erbel, M.D., Chris deKorte, Ph.D., Craig Hartley, Ph.D., Ioannis Kakadiaris, Ph.D., Roxana Mehran, M.D., Ralph Metcalfe, Ph.D., Daniel O'Leary, M.D., Jan Nilsson, M.D., Gerard Pasterkamp, M.D., Ph.D., Paul Schoenhagen, M.D., Henrik Sillesen, M.D., Ph.D.

A comprehensive and detailed scientific report of the SHAPE Task Force is currently in press by Humana Press (Springer). View the upcoming SHAPE Textbook


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