COMMENTARY

A New Aggressive Approach to Screening and Early Intervention to Prevent Death From Coronary Artery Disease

 

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We all owe a sincere debt of gratitude to Drs. Naghavi of Houston, Texas; Shah of Los Angeles, California; Falk of Aarhus, Denmark; and their assembled group of 25 authors of the SHAPE Task Force who have challenged the cardiology establishment by declaring their own ambitious new practice guideline.[1] They are unsupported as of now by any official medical organization. The guideline is intended to prevent the serious life-threatening effects of coronary artery disease in developed and developing countries. We all know the numbers. You and I are more likely to die from cardiovascular disease than anything else, even if asymptomatic. Why not use modern technology to screen for such silent killer disease and institute prevention in those found to be diseased? Indeed, why not? Well, because it costs a lot. Good reason. Because the finding may not have long-term meaning. Another good reason. Because it may produce a sense of false security. Because many of the sponsors of the Task Force work; resulting guideline; and its publication, distribution, and promotion stand to make a great deal of money from the implementation thereof, and because no clinical trials (still the gold standard) have ever shown that this kind of early detection of coronary artery disease and subsequent efforts at intervention have ever stopped anyone from dying. More good reasons. But, hey, coronary artery disease kills a whole bunch of people without any warning. Maybe we should do what we can with screening (in addition to controlling blood pressure and weight, not smoking, eating a healthy diet, staying fit, and not getting diabetes), to further prevent it. Many will be first in line to take these screening tests. I think I'll wait for some clinical trial data.

That's my opinion. I'm Dr. George Lundberg, Editor of MedGenMed.

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