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Screening for Heart Attack Preventation and Education program

Every year over a 100,000 people in Canada have a cardiac event. Heart Attack or Sudden Cardiac Death is the first presentation in over 30,000 people, and they are totally unaware of their condition. These patients are missed by the traditional methods of screening in North America using the Framingham Score which is a very good predictor for patients with high and low risk.

The moderate or intermediate risk group whose first presentation is a heart attack or sudden cardiac death are being missed. This VULNERABLE group needs to be identified. And the SHAPE Program has been designed to do so.

Screening for early detection of cancer (breast, colon and prostrate) and AIDs has been widely accepted. It is surprising that heart attack and sudden cardiac death accounts for more death and disability than all cancers and AIDs combined. But screening for sub-clinical coronary atherosclerosis has yet to be accepted as standard clinical practice. The question is how to detect these vulnerable patients, with vulnerable plaques.

Revolutionary discoveries in heart disease have changed the approach. Vulnerable plaque build up in the coronary arteries and this is how it forms (Fig 1)

  • Fat droplets are absorbed by the arteries which release proteins called cytokines that lead to inflammation (measured in the blood as HSCRP).
  • Cytokines make the artery walls sticky which attracts immune system cells called monocytes
  • Monocytes squeezes into the artery wall and turn into scavenger cells called macrophages and begin to soak up fat droplets.
  • The fat filled cells form a plaque with a thin covering(vulnerable plaque) The rupture of this thin plaque can take place in presence of other stress factors, i.e. emotional stress, smoking, a very fatty meal and fluctuations of blood pressure (diagnosed by the 24 hours Ambulatory Blood Pressure). Once the plaque cracks the contents spill out into the blood stream, the sticky cytokines in the artery wall capture blood cells mainly platelets that rush to the site of injury. When the cells clump together, they can either increase the size of the blockage and stabilize by forming a new stronger covering or completely block the artery causing a heart attack or sudden cardiac death.


New evidence has shown that blockages of less than 50%(not diagnosable by coronary angiography)(Fig 2) are the vulnerable plaques responsible for 70% of heart attacks and sudden cardiac deaths and in half of them this is the first presentation.

The other 30% of cardiac patients who are aware of their heart problems and are symptomatic usually have more than 70% blockage can be picked up by the traditional screening methods.

Landmark discoveries and major advances in diagnostic and therapeutic areas are the basis of the SHAPE initiative – it translates the new science into the new practice of prevention.

The scope of the program calls for screening of all males over 40 years and females over 50 years, in absence of sub-clinical atherosclerosis.

The presence of sub-clinical atherosclerosis is detected by Carotid Intima Media Thickness (CIMT) which is quick, low cost, no radiation exposure, and can be reassessed on a yearly basis. The alternative is Coronary Calcium Score done with the EBCT scanner which is relatively expensive, high radiation and cannot be repeated yearly and not widely available in Canada.

Once the sub-clinical atherosclerosis is detected, it is factored into the traditional risk factors to construct a risk stratification pyramid. All clients will get a full lipid profile (TC, HDL, LDL). Inflammatory marker (HSCRP). Blood sugar testing (to detect pre-diabetes and cardio-metabolic syndrome). Urine test for microalbumen (closely co-relates with future heart attack and stroke)


A 24 hours Ambulatory Blood Pressure Monitor(which is far superior to casual office recording as it co-relates better with future heart attack and strokes as it takes into consideration the physical and mental stresses during the monitoring. The recording detects white coat, masked or hidden hypertension, elevation of blood pressure while sleeping and the early morning blood pressure surge.

Stress Echo detects significant coronary artery disease with >90% sensitivity as apposed to regular stress tests which is 60%. The advantage over nuclear cardiac testing is there is no radiation, takes 30 minutes and is equally if not more accurate.

Armed with this information, the SHAPE program constructs a risk stratification pyramid. All categories of the pyramid are given TLC Therapeutic Lifestyle Change by our highly specialized team comprising of Physicians, Nutritionist, Kinesiologist and Psychologist. The program and advice is individualized with appropriate medication to halt and or reverse atherosclerosis. Special attention is given for the control of blood pressure to bring it to normal 24 hours values. The medication prescribed takes the microalbumen in the urine into account.

Patients at very high risk are referred for Angiography and or Intervention.

This not only adds years to your life, but life to your years.

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