title: Application of the screening for Heart Attack Prevention and Education Task Force recommendations to an urban population: observations from the Dallas Heart Study.
abstract: BACKGROUND
  The Screening for Heart Attack Prevention and Education (SHAPE) Task Force recommends noninvasive atherosclerosis imaging of all asymptomatic men (aged 45-75 years) and women (aged 55-75 years), except those at very low risk, to augment conventional cardiovascular risk assessment algorithms.
  
  
  METHODS
  Among 2611 participants in the Dallas Heart Study aged 30 to 65 years who underwent computed tomography to measure coronary artery calcification, low-density lipoprotein cholesterol (LDL-C) therapeutic targets were calculated using both National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) and SHAPE algorithms. The proportion of subjects reclassified as being "at goal" for LDL-C vs "not at goal" after implementation of the SHAPE recommendations was determined.
  
  
  RESULTS
  More subjects were identified with LDL-C levels greater than or equal to goal based on SHAPE than on NCEP-ATP III (27.4% vs 21.6%), with 7.0% of individuals reclassified as having unmet LDL-C goals and 1.1% of individuals reclassified as at goal. When more aggressive optional LDL-C goals were implemented, 31.7% had LDL-C levels greater than or equal to goal using SHAPE recommendations vs 28.1% using NCEP-ATP III recommendations, with 6.3% of subjects reclassified as being not at goal and 2.7% as being at goal.
  
  
  CONCLUSIONS
  The SHAPE recommendations resulted in bidirectional reclassification of eligibility for lipid-lowering therapy in subjects aged 30 to 65 years. While broad implementation of these recommendations would modestly increase cholesterol-lowering drug use in this age range, the magnitude of the increase depends on whether standard or optional LDL-C goals are targeted.
authors.affiliation: Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, TX 75390-9047, USA.
authors.forename: Raphael
authors.initials: R
authors.lastname: See
authors.forename: Jason B
authors.initials: JB
authors.lastname: Lindsey
authors.forename: Mahesh J
authors.initials: MJ
authors.lastname: Patel
authors.forename: Colby R
authors.initials: CR
authors.lastname: Ayers
authors.forename: Amit
authors.initials: A
authors.lastname: Khera
authors.forename: Darren K
authors.initials: DK
authors.lastname: McGuire
authors.forename: Scott M
authors.initials: SM
authors.lastname: Grundy
authors.forename: James A
authors.initials: JA
authors.lastname: de Lemos
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D002114:Calcinosis; D008078:Cholesterol, LDL / Q000097:blood; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D006287:Health Planning Guidelines; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control*; D010353:Patient Education as Topic; D011859:Radiography; D013781:Texas; D014505:Urban Population
chemical_list: D008078:Cholesterol, LDL