Heart Attack Tests for All?
Group of Prominent Cardiologists Calls for Radical Change in Testing for Heart Risk
July 10, 2006 -- It's time to change the way doctors predict heart attacks
and stroke, says a group of prominent cardiologists.
They call for routine use of CT scans to directly measure artery-clogging
plaque, or ultrasounds to directly measure narrowing of the arteries.
Nearly every man aged 45-75, and nearly every woman aged 55-75, would get at
least one of these tests under a new recommendation from the Association for
Eradication of Heart Attack (AEHA). The group's Screening for Heart Attack
Prevention and Education (SHAPE) task force came up with the proposal.
Reliance on the new testing technology would be a big change from current
Doctors now estimate a person's risk of heart attack by looking at a
combination of so-called risk factors. Those factors include high
blood pressure, high
cholesterol, smoking, age, diabetes, and a family history of stroke or heart disease.
But that's old hat, says AEHA.
AEHA founder and president Morteza Naghavi, MD, chaired the SHAPE task
force. "For a long time in cardiology, we dictated to individuals based on
risk factors in large populations -- which is inaccurate," Naghavi tells
WebMD. "Now we have ways to evaluate a person's risk of heart attack. We
have the means to look into the heart and see plaque. We now have
individualized risk assessment."
The new guidelines will change health care, predicts another SHAPE task
force member, Prediman K. Shah, MD, head of cardiology at
Cedars-Sinai Medical Center and professor of medicine at UCLA.
"It is a sea change in practice," Shah tells WebMD. "Since heart
attack risk starts in arteries, we should be looking there. If you can identify
plaque in a patient, then this individual -- regardless of risk factors -- is
actually at risk. If you want to identify people with heart disease, don't look
at risk factors. We say, look directly at where the plaque is."
Do Guidelines Promise Too Much, Too Soon?
The SHAPE guidelines appear in the July 10 issue of the American Journal
of Cardiology. The authors include a long list of prominent heart
But some other prominent specialists aren't signing on, arguing the
technology can not yet do what the AEHA group suggests. One is Eric J. Topol,
MD, professor of genetics at Cleveland's Case Western Reserve University, and
one of the world's 10 most-cited biomedical researchers.
"This organization is taking a very aggressive approach," Topol
says. "It says we are ready to screen the arteries directly," he tells
WebMD. "They want to noninvasively detect plaques days, weeks, or months
before they will cause trouble. But no technique can do this. They are not even
"Many years from now this may be possible. But we are not there
yet," says Topol.