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    Heart Attack Tests for All?

    Group of Prominent Cardiologists Calls for Radical Change in Testing for Heart Risk

    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 specialists.

    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 close yet.

    "Many years from now this may be possible. But we are not there yet," says Topol.

    No Change in Official Guidelines

    The SHAPE recommendations won't change official U.S. guidelines, says Diane Bild, MD, deputy director of the division of epidemiology and clinical applications at the National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda, Md.

    "What we really need for [federal] guideline recommendations is just not available yet," Bild tells WebMD. "This is a laudable effort to move preventive cardiology forward. But it occurs with a lack of the complete and clear information that we need to make guidelines.

    "The tests are out there. They are being used," Bild says. "It is just not clear what the value of these tests really is -- and whether treatment should be targeted based on those tests."

    Naghavi bristles at the argument that the screening tests aren't ready for prime time.

    Tests Uncover Major Risks

    "To those who say the technology isn't there yet, we say check with recent discoveries," Naghavi says.

    "For the very first time in heart medicine, we now have a test that can show someone has up to a 65-fold increased risk of a heart attack," he says. "With the traditional risk factors, the biggest risk is high cholesterol, which has only up to 4.5-fold increased risk. So you can see how much of a jump in prediction we get from this."

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