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
Revolutionary discoveries in heart disease have
changed the approach. Vulnerable plaque build up
in the coronary arteries and this is how it forms
Fat droplets are absorbed by the arteries which
release proteins called cytokines that lead
(measured in the blood as HSCRP).
make the artery walls sticky which attracts
immune system cells called 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
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
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
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.