Could new CVD prevention guidelines for women cause overtreatment?

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The Society for Heart Attack Prevention and Eradication (SHAPE) has issued a letter to Circulation and the New England Journal of Medicine expressing concern about the 2011 update to the American Heart Association's guideline for the prevention of cardiovascular disease (CVD) in women.

By arbitrarily lowering and deflating the cutoff point for the high-risk category from 20 percent to 10 percent and continuing to rely solely on traditional risk factors to measure an individual's risk, the new guideline could result in massive overtreatment and undue "high risk" labeling of many otherwise healthy women, according to the nonprofit organization.

"The primary reason our existing national CVD prevention guidelines do not work in women is not because the guidelines have a high threshold, but because they are based on less than precise measures of the disease," said Prediman K. Shah, MD, chairman of the SHAPE scientific board and director of the division of cardiology at Cedars-Sinai Heart Institute and Medical Center in Los Angeles.

"Measuring traditional risk factors alone is not enough to characterize atherothrombotic risk, especially in intermediate risk cohorts. Such patients could benefit from a more individualized risk assessment when measures of subclinical atherosclerosis are included in the risk prediction strategy," he said.

The SHAPE task force recommends physicians use either coronary artery calcification (CAC) scoring by a CT scan or carotid intima-media thickness (CIMT) and plaque scanning by ultrasound. By implementing screening for asymptomatic atherosclerosis in women aged 55 and older who have a Framingham risk score of 6 percent or greater, physicians can improve their risk assessment and take appropriate preventive measures, according to the task force.

Existing guidelines inexplicably hesitate to exploit the full benefit of testing for subclinical atherosclerosis in the primary prevention of CVD.

"To prevent massive overtreatment and undue 'high risk' labeling of healthy women, SHAPE is urging the new AHA guideline be amended to incorporate the responsible use of scientifically proven noninvasive tests for subclinical atherosclerosis," said Erling Falk, MD, PhD, chief of the SHAPE Task Force II editorial committee and a professor of cardiovascular pathology at Aarhus University Hospital in Denmark.