SHAPE getting ready to update its controversial guidelines

The Society for Heart Attack Prevention and Eradication (SHAPE) has announced the formation of a new task force “to refine and update” its earlier published guidelines. The SHAPE Task Force II held its initial meeting on July 30-August 1, according to the organization. Morteza Naghavi is the Executive Chairman of the Task Force, while PK Shah is the Chair of the Scientific Board and Erling Falk is the Chief of the Editorial Committee.

The earlier guidelines, when published in a supplement to the American Journal of Cardiology, were not endorsed by the ACC, AHA, or the NHLBI, and received a mixed response from the cardiology community. A typical response came from Robert Califf, who told heartwire: “It’s an opinion, it’s not a guideline that’s been vetted through any kind of ecumenical group of people who have any official standing to make clinical-practice guidelines. There’s enough evidence to have an opinion about this; I don’t think there’s enough evidence to have a policy about it. It’s an interesting idea and it could be right. Then again, it may not be right.”

A further complicating factor is the role of SHAPE’s founder and current chairman,  Morteza Naghavi, who has numerous financial interests in technologies and devices that stand to benefit from SHAPE policies and the Texas legislation.

On the other hand, the AJC supplement was introduced by a prominent cardiologist, Valentin Fuster, and co-authors of the guidelines included such leading  figures as PK Shah, Pam Douglas, Sanjay Kaul, and others. Many cardiologists, though critical of SHAPE and its methods,nevertheless broadly support efforts to identify people at high risk for MI.

The SHAPE press release announcing the new Task Force (see below) takes no note of the controversy and calls the publication “a major breakthrough in preventive cardiology.” The press release also refers to a bill passed last year in Texas that requires reimbursement for heart attack screening, but does not mention that the bill was actively supported and promoted by SHAPE, and that SHAPE was widely criticized for its role in promoting the legislation.

Here is previous CardioBrief coverage of SHAPE:

Here is the SHAPE press release:

SHAPE Task Force II Convenes to Review and Update SHAPE Guideline for Heart Attack Prevention

Houston, TX (PRWEB) August 9, 2010

SHAPE, The Society for Heart Attack Prevention and Eradication ( (, a nonprofit organization that promotes the early detection and preventive intervention to reduce heart attack risk, today announced the formation of SHAPE Task Force II to refine and update the First SHAPE Guideline. SHAPE Task Force II is an international group of leading cardiologists and cardiovascular researchers who share the belief that healthcare providers can do more, using non-invasive imaging tests, to assess and reduce an asymptomatic individual’s heart attack risk.

The publication of the First SHAPE Guideline was a major breakthrough in preventive cardiology. Published in the American Journal of Cardiology in 2006, it was the first guideline for screening to identify hidden coronary artery disease. The First SHAPE Guideline established standards for the careful and responsible implementation of scientifically proven atherosclerosis tests to detect hidden plaque buildup in coronary and carotid arteries, and recommended the tests be incorporated into routine screening for asymptomatic (apparently healthy) men and women as they age. SHAPE Task Force II will consider what has been learned through research and medical practice during the past four years and is expected to integrate these advances into an updated Second SHAPE Guideline.

Like the First SHAPE Guideline, the Second SHAPE Guideline is expected to address the following: what portion of the population should have an atherosclerosis test; what tests for the detection of atherosclerosis currently fulfill stringent criteria to be recommended; how to stratify the severity of an individual patient’s heart attack risk based on the outcomes of the atherosclerosis test; and patient care objectives based on individual heart attack risk severity.

“The pace of advances in preventive cardiology in the years since the publication of the First SHAPE Guideline necessitates this review to ensure physicians and patients around the world benefit from scientifically valid methods of heart attack risk assessment and reduction strategies,” said Dr. PK Shah, chairman of the SHAPE Scientific Board and director, Division of Cardiology at Cedars-Sinai Heart Institute and Medical Center in Los Angeles. “This effort to refine and update the SHAPE Guideline is based on scientific proof that atherosclerosis tests can discover heart attack risk in apparently healthy patients early enough to give physicians an opportunity to persuade at risk individuals to implement intensive therapies before it’s too late.”

Heart attack and stroke account for more death and disability than all cancers combined. SHAPE believes scientifically proven screening tests for subclinical atherosclerosis, which triggers heart attack and stroke, deserve the same standardized use as routine screening tests for subclinical cancers such as mammography and colonoscopy.

“We are embarking on an exciting process. Everything is open for review, including how old a patient should be, whether traditional risk factors should be considered, whether biomarkers should be added or removed from the Guideline and how to match the intensity of treatment to the severity of heart attack risk to ensure patients get the best individualized care they need,” said Erling Falk, M.D., Ph.D., chief of the SHAPE Task Force II Editorial Committee who is also Professor of Cardiovascular Pathology at Aarhus University Hospital in Aarhus, Denmark. “This is an open process and we invite cardiologists and researchers around the world to share their thoughts and ideas via the SHAPE Task Force II online forum.”

To participate in the SHAPE Task Force II online forum, visit ( The online discussion will be considered by the SHAPE Task II editorial committee as it prepares the Second SHAPE Guideline.

The medical establishment has been slow to adopt atherosclerosis tests, instead relying on traditional risk factors to identify men and women at risk for heart attack. The approach has only been partially effective. Nearly 50 percent of heart attack victims are unaware they have a buildup of plaque because it is not checked, and they do not exhibit traditional warning signs such as alarmingly high cholesterol and blood pressure.

Meanwhile, the passage of time has removed numerous obstacles to adoption of recommended atherosclerosis tests. SHAPE Task Force II is reviewing findings from the groundbreaking Multi-Ethnic Study of Atherosclerosis (MESA) that has further substantiated the predictive value of the atherosclerosis tests included in the First SHAPE Guideline. SHAPE Task Force II also heard presentations regarding testing methods that have significantly reduced radiation from CT scans of the heart’s arteries.

Additionally, the wider use of atherosclerosis tests has improved the affordability of the procedures. In major U.S. cities patients pay approximately $100 to have their coronary artery calcium score (CACS) measured by CT scan or carotid intima-media thickness (CIMT) and carotid plaque measured by ultrasonography. And progress is being made to persuade insurance companies to cover the costs of such preventive screening tests in the interests of public health and prevention. In 2009, Texas Governor Rick Perry signed the nation’s first heart Attack Preventive Screening Bill into law requiring insurance reimbursement for the tests.

To view videos of interviews with SHAPE Task Force II participants, visit (

The SHAPE Task Force II includes the following:

Morteza Naghavi, M.D. – Executive Chairman
PK Shah, M.D. – Chair of Scientific Board
Erling Falk, M.D., Ph.D. – Chief of Editorial Committee

SHAPE Task Force II Members:

Daniel S. Berman, M.D., Matthew J. Budoff, M.D., Michael H. Davidson, M.D., Jim Ehrlich, M.D., Raimund Erbel, M.D., Erling Falk, M.D., Ph.D., Steven B. Feinstein, M.D., Kirk Geter, D.P.M., Craig Hartley, Ph.D., Harvey S. Hecht, M.D., Howard Hodis, M.D., Sanjay Kaul, M.D., M.P.H., Iftikhar J. Kullo, M.D., Daniel Lane, M.D., Ph.D., Marge Lovell, R.N., Ralph Metcalfe, Ph.D., Tasneem Z. Naqvi, M.D., Morteza Naghavi, M.D., Paolo Raggi, M.D., George P. Rodgers, M.D., PK Shah, M.D., David Spence, M.D., H. Robert Superko, M.D., Henrik Sillesen, M.D., Ph.D., Pierre-Jean Touboul, M.D.

SHAPE Task Force II Advisors:

Roger Blumenthal, M.D., Valentin Fuster, M.D., Ph.D., Leslee Shaw, Ph.D.

SHAPE Task Force II Executive Coordinator: Jeff Fine, M.S., Ph.D.

The initial meeting of SHAPE Task Force II was held July 30 – August 1, 2010. The event was sponsored through unrestricted educational grants from the Panasonic Corporation and CardioDx, Inc.


Based in Houston, the Society for Heart Attack Prevention and Eradication (SHAPE) is a non-profit organization that promotes education and research related to prevention, detection, and treatment of heart attacks. SHAPE is committed to raising public awareness about revolutionary discoveries that are opening exciting avenues to prevent heart attacks. SHAPE’s mission is to eradicate heart attacks in the 21st century. Additional information is available on the organization’s Web site at




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