1. Are We There Yet ? Abdul H. Sankari, MD FACC FCCP

2. Screening, defined Screening is a process that aims to identify disease prior to the point of clinical presentation in order to intervene more effectively

3. CVD vs Cancer mortality In 2002 657,000 death from MI and stroke Vs 557,000 from all cancers. Still screening for occult Breast, Colon, and breast cancer has become a widley accepted public policy, but screening for atherosclerosis (the leading cause of CHD and Stroke) has not.

4. Traditional Risk Assessment models Framingham Risk Score Systemic Coronary Risk Evaluation (SCORE) A 10 years probability of developing CAD, Based on Gender, Age, BP, Lipids, and Smoking history

5. LIMITATIONS Poor sensitivity (36% for women and 74% for men) Compared with 97 and 98% for calcium scoring Will allow for recognition of a very high or very low risk patients, however, the Intermediate risk group (where most Heart attacks and Stroke will occur)is poorly recognized.

6. LIMITATIONS 2 In the US the prevelance of more than one risk factor is very High among indivisuals over 40y of age who develop CHD, but also very high in indivisuals that don’t

7. How to properly Screen Identify Abnormal Arterial structure and function (Vulnerable patient /Vulnerable Myocardium/ vulnerable Blood/ Vulnerable plaque) Guidelines New screening tools Coronary Calcium score CIMT ABI CRP

8. WHY SCREEN CHD is the leading cause of mortality in men & women causing more than 1 in 5 deaths An estimated 875,000 will have their first heart attack annually and 500,000 will have a recurrent MI Stroke is the number 3 cause of mortality and the leading cause of long term disability An estimated 700,000 will have a stroke annually

9. SHAPE recommendations All men 45-75 y and women 55-75 should undergo screening

10. Very high High Risk Moderate risk

11. Low Risk CACS = 0 CIMT < 50 th percentile, no carotid plaque

12. Moderate Risk CACS = 0 CIMT < 50 th percentile Have Traditional Risk factors

13. Moderatly High Risk CACS = 1-100 CIMT < 1mm. 51-75 th percentile---no plaque

14. High Risk CACS = 101-399 Cimt > 1mm or > 75 th percentile

15. Very High Risk CACS > 400 CIMT : Carotid plaque with > 50% stenosis