The Experts below are selected from a list of 15519 Experts worldwide ranked by ideXlab platform
Tzicker Chiueh - One of the best experts on this subject based on the ideXlab platform.
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IAS - Web Application Attack Prevention for Tiered Internet Services
2008 The Fourth International Conference on Information Assurance and Security, 2008Co-Authors: Susanta Nanda, Lap-chung Lam, Tzicker ChiuehAbstract:Because most Web application Attacks exploit vulnerabilities that result from lack of input validation, a promising approach to thwarting these Attacks is to apply validation checks on tainted portions of the operands used in security-sensitive operations, where a byte is tainted if it is data/control dependent on some network packet(s). This paper presents the design, implementation and evaluation of a dynamic checking compiler called WASC, which automatically adds checks into Web applications used in three-tier Internet services to protect them from the most common two types of Web application Attacks: SQL- and script-injection Attack. In addition to including a taint analysis infrastructure for multi-process and multi-language applications, WASC features the use of SQL and HTML parsers to defeat evasion techniques that exploit interpretation differences between Attack detection engines and target applications. Experiments with a fully operational WASC prototype show that it can indeed stop all SQL/script injection Attacks that we have tested. Moreover, the end-to-end latency penalty associated with the checks inserted by WASC is less than 30% for the test Web applications used in our performance study.
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automated format string Attack Prevention for win32 x86 binaries
Annual Computer Security Applications Conference, 2007Co-Authors: Tzicker ChiuehAbstract:A format string Attack exploits the fact that variadic functions determine the exact number of input arguments based on the format string argument, and compromises the victim application's address space by accessing data areas beyond the original input argument list the caller prepares. This paper describes the design, implementation and evaluation of a Win32 binary transformation tool called Lisbon, which transparently inserts into Win32 binaries additional checks that protect them from format string vulnerabilities. Lisbon casts the format string Attack Prevention problem as an input argument list bound checking problem. To reduce the run-time checking overhead, Lisbon exploits the debug register hardware, which is available in most mainstream CPUs including Intel's X86 architecture, to detect if a callee accesses data outside the input argument list. Moreover, Lisbon is able to detect format string Attacks without interpreting their format strings and is thus potentially applicable to similar Attacks against other functions that access input arguments in the same way as printf (). The runtime throughput penalty of the first Lisbon prototype is under 2% for a set of test network applications that are known to be vulnerable to format string Attacks.
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Automated format string Attack Prevention for win32/x86 binaries
2007Co-Authors: Tzicker ChiuehAbstract:A format string Attack exploits the fact that variadic functions determine the exact number of input arguments based on the format string argument, and compromises the victim application’s address space by accessing data areas beyond the original input argument list the caller prepares. This paper describes the design, implementation and evaluation of a Win32 binary transformation tool called Lisbon, which transparently inserts into Win32 binaries additional checks that protect them from format string vulnerabilities. Lisbon casts the format string Attack Prevention problem as an input argument list bound checking problem. To reduce the run-time checking overhead, Lisbon exploits the debug register hardware, which is available in most mainstream CPUs including Intel’s X86 architecture, to detect if a callee accesses data outside the input argument list. Moreover, Lisbon is able to detect format string Attacks without interpreting their format strings and is thus potentially applicable to similar Attacks against other functions that access input arguments in the same way as printf(). The runtime throughput penalty of the first Lisbon prototype is under 2 % for a set of test network applications that are known to be vulnerable to format string Attacks. 1
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ACSAC - Automated Format String Attack Prevention for Win32/X86 Binaries
Twenty-Third Annual Computer Security Applications Conference (ACSAC 2007), 2007Co-Authors: Tzicker ChiuehAbstract:A format string Attack exploits the fact that variadic functions determine the exact number of input arguments based on the format string argument, and compromises the victim application's address space by accessing data areas beyond the original input argument list the caller prepares. This paper describes the design, implementation and evaluation of a Win32 binary transformation tool called Lisbon, which transparently inserts into Win32 binaries additional checks that protect them from format string vulnerabilities. Lisbon casts the format string Attack Prevention problem as an input argument list bound checking problem. To reduce the run-time checking overhead, Lisbon exploits the debug register hardware, which is available in most mainstream CPUs including Intel's X86 architecture, to detect if a callee accesses data outside the input argument list. Moreover, Lisbon is able to detect format string Attacks without interpreting their format strings and is thus potentially applicable to similar Attacks against other functions that access input arguments in the same way as printf (). The runtime throughput penalty of the first Lisbon prototype is under 2% for a set of test network applications that are known to be vulnerable to format string Attacks.
Tasneem Z. Naqvi - One of the best experts on this subject based on the ideXlab platform.
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From Vulnerable Plaque to Vulnerable Patient—Part III: Executive Summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force Report
The American Journal of Cardiology, 2006Co-Authors: Morteza Naghavi, Michael J. Jamieson, Harvey S. Hecht, Matthew J. Budoff, Erling Falk, Sanjay Kaul, Daniel S. Berman, Zahi A. Fayad, John A. Rumberger, Tasneem Z. NaqviAbstract:Screening for early-stage asymptomatic cancers (eg, cancers of breast and colon) to prevent late-stage malignancies has been widely accepted. However, although atherosclerotic cardiovascular disease (eg, heart Attack and stroke) accounts for more death and disability than all cancers combined, there are no national screening guidelines for asymptomatic (subclinical) atherosclerosis, and there is no governmentor healthcare-sponsored reimbursement for atherosclerosis screening. Part I and Part II of this consensus statement elaborated on new discoveries in the field of atherosclerosis that led to the concept of the “vulnerable patient.” These landmark discoveries, along with new diagnostic and therapeutic options, have set the stage for the next step: translation of this knowledge into a new practice of preventive cardiology. The identification and treatment of the vulnerable patient are the focuses of this consensus statement. In this report, the Screening for Heart Attack Prevention and Education (SHAPE) Task Force presents a new practice guideline for cardiovascular screening in the asymptomatic at-risk population. In summary, the SHAPE Guideline calls for noninvasive screening of all asymptomatic men 45‐75 years of age and asymptomatic women 55‐75 years of age (except those defined as very low risk) to detect and treat those with subclinical atherosclerosis. A variety of screening tests are available, and the cost-effectiveness of their use in a comprehensive strategy must be validated. Some of these screening tests, such as measurement of coronary artery calcification by computed tomography scanning and carotid artery intima‐media thickness and plaque by ultrasonography, have been available longer than others and are capable of providing direct evidence for the presence and extent of atherosclerosis. Both of these imaging methods provide prognostic information of proven value regarding the future risk of heart Attack and stroke. Careful and responsible implementation of these tests as part of a comprehensive risk assessment and reduction approach is warranted and outlined by this report. Other tests for the detection of atherosclerosis and abnormal arterial structure and function, such as magnetic resonance imaging of the great arteries, studies of small and large artery stiffness, and assessment of systemic endothelial dysfunction, are emerging and must be further validated. The screening results (severity of subclinical arterial disease) combined with risk factor assessment are used for risk stratification to identify the vulnerable patient and initiate appropriate therapy. The higher the risk, the more vulnerable an individual is to a near-term adverse event. Because
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from vulnerable plaque to vulnerable patient part iii executive summary of the screening for heart Attack Prevention and education shape task force report
American Journal of Cardiology, 2006Co-Authors: Morteza Naghavi, Michael J. Jamieson, Harvey S. Hecht, Matthew J. Budoff, Erling Falk, Sanjay Kaul, Daniel S. Berman, Zahi A. Fayad, John A. Rumberger, Tasneem Z. NaqviAbstract:Screening for early-stage asymptomatic cancers (eg, cancers of breast and colon) to prevent late-stage malignancies has been widely accepted. However, although atherosclerotic cardiovascular disease (eg, heart Attack and stroke) accounts for more death and disability than all cancers combined, there are no national screening guidelines for asymptomatic (subclinical) atherosclerosis, and there is no governmentor healthcare-sponsored reimbursement for atherosclerosis screening. Part I and Part II of this consensus statement elaborated on new discoveries in the field of atherosclerosis that led to the concept of the “vulnerable patient.” These landmark discoveries, along with new diagnostic and therapeutic options, have set the stage for the next step: translation of this knowledge into a new practice of preventive cardiology. The identification and treatment of the vulnerable patient are the focuses of this consensus statement. In this report, the Screening for Heart Attack Prevention and Education (SHAPE) Task Force presents a new practice guideline for cardiovascular screening in the asymptomatic at-risk population. In summary, the SHAPE Guideline calls for noninvasive screening of all asymptomatic men 45‐75 years of age and asymptomatic women 55‐75 years of age (except those defined as very low risk) to detect and treat those with subclinical atherosclerosis. A variety of screening tests are available, and the cost-effectiveness of their use in a comprehensive strategy must be validated. Some of these screening tests, such as measurement of coronary artery calcification by computed tomography scanning and carotid artery intima‐media thickness and plaque by ultrasonography, have been available longer than others and are capable of providing direct evidence for the presence and extent of atherosclerosis. Both of these imaging methods provide prognostic information of proven value regarding the future risk of heart Attack and stroke. Careful and responsible implementation of these tests as part of a comprehensive risk assessment and reduction approach is warranted and outlined by this report. Other tests for the detection of atherosclerosis and abnormal arterial structure and function, such as magnetic resonance imaging of the great arteries, studies of small and large artery stiffness, and assessment of systemic endothelial dysfunction, are emerging and must be further validated. The screening results (severity of subclinical arterial disease) combined with risk factor assessment are used for risk stratification to identify the vulnerable patient and initiate appropriate therapy. The higher the risk, the more vulnerable an individual is to a near-term adverse event. Because <10% of the population who test positive for atherosclerosis will experience a near-term event, additional risk stratification based on reliable markers of disease activity is needed and is expected to further focus the search for the vulnerable patient in the future. All individuals with asymptomatic atherosclerosis should be counseled and treated to prevent progression to overt
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From vulnerable plaque to vulnerable patient--Part III: Executive summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force report.
The American journal of cardiology, 2006Co-Authors: Morteza Naghavi, Michael J. Jamieson, Harvey S. Hecht, Matthew J. Budoff, Erling Falk, Sanjay Kaul, John A. Rumberger, Daniel Berman, Zahi Fayad, Tasneem Z. NaqviAbstract:Screening for early-stage asymptomatic cancers (eg, cancers of breast and colon) to prevent late-stage malignancies has been widely accepted. However, although atherosclerotic cardiovascular disease (eg, heart Attack and stroke) accounts for more death and disability than all cancers combined, there are no national screening guidelines for asymptomatic (subclinical) atherosclerosis, and there is no government- or healthcare-sponsored reimbursement for atherosclerosis screening. Part I and Part II of this consensus statement elaborated on new discoveries in the field of atherosclerosis that led to the concept of the "vulnerable patient." These landmark discoveries, along with new diagnostic and therapeutic options, have set the stage for the next step: translation of this knowledge into a new practice of preventive cardiology. The identification and treatment of the vulnerable patient are the focuses of this consensus statement. In this report, the Screening for Heart Attack Prevention and Education (SHAPE) Task Force presents a new practice guideline for cardiovascular screening in the asymptomatic at-risk population. In summary, the SHAPE Guideline calls for noninvasive screening of all asymptomatic men 45-75 years of age and asymptomatic women 55-75 years of age (except those defined as very low risk) to detect and treat those with subclinical atherosclerosis. A variety of screening tests are available, and the cost-effectiveness of their use in a comprehensive strategy must be validated. Some of these screening tests, such as measurement of coronary artery calcification by computed tomography scanning and carotid artery intima-media thickness and plaque by ultrasonography, have been available longer than others and are capable of providing direct evidence for the presence and extent of atherosclerosis. Both of these imaging methods provide prognostic information of proven value regarding the future risk of heart Attack and stroke. Careful and responsible implementation of these tests as part of a comprehensive risk assessment and reduction approach is warranted and outlined by this report. Other tests for the detection of atherosclerosis and abnormal arterial structure and function, such as magnetic resonance imaging of the great arteries, studies of small and large artery stiffness, and assessment of systemic endothelial dysfunction, are emerging and must be further validated. The screening results (severity of subclinical arterial disease) combined with risk factor assessment are used for risk stratification to identify the vulnerable patient and initiate appropriate therapy. The higher the risk, the more vulnerable an individual is to a near-term adverse event. Because
Morteza Naghavi - One of the best experts on this subject based on the ideXlab platform.
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Radiation exposure and coronary artery calcium scans in the society for heart Attack Prevention and eradication cohort.
The international journal of cardiovascular imaging, 2018Co-Authors: Amish A. Patel, Morteza Naghavi, Jeffrey J. Fine, Matthew J. BudoffAbstract:Coronary artery calcium (CAC) scoring is used in asymptomatic patients to improve their clinically predicted risk for future cardiovascular events. Current CT protocols seek to reduce radiation exposure without diminishing image quality. Reported radiation exposure remains widely variable (0.8–5 mSv) depending on the type of protocol. In this study, we report the radiation exposure of CAC scoring from the Society for Heart Attack Prevention and Eradication (SHAPE) early detection program cohort sites, which spanned multiple centers using 64-MDCT (multi-detector computed tomography) scanners. We reviewed radiation exposure in milliSieverts (mSv) for 82,214 participants from the SHAPE early detection program cohort who underwent CAC scoring. This occurred over a 2.5-year period (2012–2014) divided among 33 sites in 7 countries with four different types 64-MDCT scanners. The effective radiation dose was reported as mSv. Mean radiation dosing amongst all 82,214 participants was 1.03 mSv, a median dose of 0.94 mSv. The mean radiation dose ranged from 0.76 to 1.31 mSv across the 33 sites involved with the SHAPE program cohort. Subgroup analysis by age, gender or body mass index (BMI) less than 30 kg/m2 showed no variability. Radiation dose in patients with BMI > 30 kg/m2 were significantly greater than other subgroups (µ = 1.96 mSv, p
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The Multiconstituent Cardiovascular Pill (MCCP): Challenges and Promises of Population Based Prophylactic Drug Therapy for Heart Attack Prevention and Eradication
Asymptomatic Atherosclerosis, 2010Co-Authors: Michael J. Jamieson, Harvey S. Hecht, Morteza NaghaviAbstract:Risk factors for atherosclerotic cardiovascular disease (CVD) are highly coprevalent but have been poorly identified and treated. The Screening for Heart Attack Prevention and Education (SHAPE) Task Force from the Society for Heart Attack Prevention and Eradication (SHAPE) has proposed a new strategy that recommends screening for subclinical atherosclerosis and implementing aggressive treatment of “vulnerable patients”. The Task Force has also envisioned future developments that may shift mass screening strategies to mass prophylactic therapy. The “Polypill” concept, introduced by Wald and Law, suggests that a combination of statin, low-dose anti-hypertensive, aspirin and folic acid in a single pill taken prophylactically by a high risk population can cut CVD event rates by as much as 80%. In this communication, we review the challenges and promises of such a strategy. “Polypill” is but one of an almost infinite number of possible multiconstituent pills (MCCP). The MCCP concept, although attractive, lacks evidence from randomized controlled trials. The following need to be addressed: credibility of the concept, design and synthesis of such complex pills, pharmacokinetics, pharmacodynamics, bioequivalence, “class” vs. unique properties, interactions, clinical efficacy and safety, regulatory approval, post-marketing surveillance, prescription vs. over-the- counter use, responsibility for initiating and monitoring therapy, patient education, counterfeiting and importation, reimbursement, advertisement, patent protection, and commercial viability. If these issues are favorably addressed, MCCP is poised to dramatically alter the face of CVD Prevention, particularly in developing societies. Universal adoption of highly effective, safe, and inexpensive MCCP has the potential to become a major public healthcare initiative in the movement for the worldwide eradication of heart Attacks. Nonetheless, in the absence of commercial interests, realizing the promise of MCCP will demand serious attention from national public health policymakers.
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preventive cardiology the shape of the future a synopsis from the screening for heart Attack Prevention and education shape task force report
Herz, 2007Co-Authors: Morteza NaghaviAbstract:: Traditional guidelines for Prevention of atherosclerotic cardiovascular disease (ACVD) fail to identify very-high-risk individuals (the vulnerable patient) who have extensive atherosclerotic plaques in coronary and other arteries thereby at risk for a near future adverse event. They solely rely on screening for traditional risk factors of atherosclerosis (e.g., cholesterol, blood pressure, smoking, etc.) and do not treat differently those with and without extensive atherosclerotic plaques who have a similar risk factor profile (e.g., Framingham Risk Score). Recent studies have consistently shown that individuals with extensive plaque burden regardless of their risk factor profile are very high risk. Traditional risk factor-based guidelines clearly miss to identify the vulnerable patient whose risk factor profile is normal or borderline (i.e., low- or intermediate-risk categories). Often individuals with similar risk factor profiles have different levels of coronary plaque burden and are on different trajectories for a future cardiovascular event. Risk factors of atherosclerosis are at best predictors of ACVD but cannot identify who has or does not have the disease. While such an approach was the best available method in the 70s and 80s, we now have new noninvasive tools capable of detecting atherosclerosis itself. The existing traditional guidelines for primary Prevention of ACVD need to be updated to save the vulnerable patient. To address this problem, the Association for Eradication of Heart Attack, a grassroots organization founded by a group of cardiovascular physicians and researchers, has proposed the SHAPE (Screening for Heart Attack Prevention and Education) guideline based on consensus among an international group of distinguished cardiovascular experts. The SHAPE guideline aims to complement existing guidelines in preventive cardiology and address the detection and treatment of the vulnerable patient. The SHAPE Task Force has thoroughly reviewed available evidence including recent studies and recommended that all asymptomatic men 45-75 years and women 55-75 years (except for a small group < 5% with a very low risk factor profile) must undergo noninvasive screening to detect and measure the amount of hidden atherosclerotic plaques in their coronary or carotid arteries. The higher the amount of plaques the more intensive treatment is recommended. The SHAPE Task Force urges health-care policy makers to update existing national guidelines for primary Prevention of atherosclerotic cardiovascular disease.
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From Vulnerable Plaque to Vulnerable Patient—Part III: Executive Summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force Report
The American Journal of Cardiology, 2006Co-Authors: Morteza Naghavi, Michael J. Jamieson, Harvey S. Hecht, Matthew J. Budoff, Erling Falk, Sanjay Kaul, Daniel S. Berman, Zahi A. Fayad, John A. Rumberger, Tasneem Z. NaqviAbstract:Screening for early-stage asymptomatic cancers (eg, cancers of breast and colon) to prevent late-stage malignancies has been widely accepted. However, although atherosclerotic cardiovascular disease (eg, heart Attack and stroke) accounts for more death and disability than all cancers combined, there are no national screening guidelines for asymptomatic (subclinical) atherosclerosis, and there is no governmentor healthcare-sponsored reimbursement for atherosclerosis screening. Part I and Part II of this consensus statement elaborated on new discoveries in the field of atherosclerosis that led to the concept of the “vulnerable patient.” These landmark discoveries, along with new diagnostic and therapeutic options, have set the stage for the next step: translation of this knowledge into a new practice of preventive cardiology. The identification and treatment of the vulnerable patient are the focuses of this consensus statement. In this report, the Screening for Heart Attack Prevention and Education (SHAPE) Task Force presents a new practice guideline for cardiovascular screening in the asymptomatic at-risk population. In summary, the SHAPE Guideline calls for noninvasive screening of all asymptomatic men 45‐75 years of age and asymptomatic women 55‐75 years of age (except those defined as very low risk) to detect and treat those with subclinical atherosclerosis. A variety of screening tests are available, and the cost-effectiveness of their use in a comprehensive strategy must be validated. Some of these screening tests, such as measurement of coronary artery calcification by computed tomography scanning and carotid artery intima‐media thickness and plaque by ultrasonography, have been available longer than others and are capable of providing direct evidence for the presence and extent of atherosclerosis. Both of these imaging methods provide prognostic information of proven value regarding the future risk of heart Attack and stroke. Careful and responsible implementation of these tests as part of a comprehensive risk assessment and reduction approach is warranted and outlined by this report. Other tests for the detection of atherosclerosis and abnormal arterial structure and function, such as magnetic resonance imaging of the great arteries, studies of small and large artery stiffness, and assessment of systemic endothelial dysfunction, are emerging and must be further validated. The screening results (severity of subclinical arterial disease) combined with risk factor assessment are used for risk stratification to identify the vulnerable patient and initiate appropriate therapy. The higher the risk, the more vulnerable an individual is to a near-term adverse event. Because
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from vulnerable plaque to vulnerable patient part iii executive summary of the screening for heart Attack Prevention and education shape task force report
American Journal of Cardiology, 2006Co-Authors: Morteza Naghavi, Michael J. Jamieson, Harvey S. Hecht, Matthew J. Budoff, Erling Falk, Sanjay Kaul, Daniel S. Berman, Zahi A. Fayad, John A. Rumberger, Tasneem Z. NaqviAbstract:Screening for early-stage asymptomatic cancers (eg, cancers of breast and colon) to prevent late-stage malignancies has been widely accepted. However, although atherosclerotic cardiovascular disease (eg, heart Attack and stroke) accounts for more death and disability than all cancers combined, there are no national screening guidelines for asymptomatic (subclinical) atherosclerosis, and there is no governmentor healthcare-sponsored reimbursement for atherosclerosis screening. Part I and Part II of this consensus statement elaborated on new discoveries in the field of atherosclerosis that led to the concept of the “vulnerable patient.” These landmark discoveries, along with new diagnostic and therapeutic options, have set the stage for the next step: translation of this knowledge into a new practice of preventive cardiology. The identification and treatment of the vulnerable patient are the focuses of this consensus statement. In this report, the Screening for Heart Attack Prevention and Education (SHAPE) Task Force presents a new practice guideline for cardiovascular screening in the asymptomatic at-risk population. In summary, the SHAPE Guideline calls for noninvasive screening of all asymptomatic men 45‐75 years of age and asymptomatic women 55‐75 years of age (except those defined as very low risk) to detect and treat those with subclinical atherosclerosis. A variety of screening tests are available, and the cost-effectiveness of their use in a comprehensive strategy must be validated. Some of these screening tests, such as measurement of coronary artery calcification by computed tomography scanning and carotid artery intima‐media thickness and plaque by ultrasonography, have been available longer than others and are capable of providing direct evidence for the presence and extent of atherosclerosis. Both of these imaging methods provide prognostic information of proven value regarding the future risk of heart Attack and stroke. Careful and responsible implementation of these tests as part of a comprehensive risk assessment and reduction approach is warranted and outlined by this report. Other tests for the detection of atherosclerosis and abnormal arterial structure and function, such as magnetic resonance imaging of the great arteries, studies of small and large artery stiffness, and assessment of systemic endothelial dysfunction, are emerging and must be further validated. The screening results (severity of subclinical arterial disease) combined with risk factor assessment are used for risk stratification to identify the vulnerable patient and initiate appropriate therapy. The higher the risk, the more vulnerable an individual is to a near-term adverse event. Because <10% of the population who test positive for atherosclerosis will experience a near-term event, additional risk stratification based on reliable markers of disease activity is needed and is expected to further focus the search for the vulnerable patient in the future. All individuals with asymptomatic atherosclerosis should be counseled and treated to prevent progression to overt
Michael J. Jamieson - One of the best experts on this subject based on the ideXlab platform.
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The Multiconstituent Cardiovascular Pill (MCCP): Challenges and Promises of Population Based Prophylactic Drug Therapy for Heart Attack Prevention and Eradication
Asymptomatic Atherosclerosis, 2010Co-Authors: Michael J. Jamieson, Harvey S. Hecht, Morteza NaghaviAbstract:Risk factors for atherosclerotic cardiovascular disease (CVD) are highly coprevalent but have been poorly identified and treated. The Screening for Heart Attack Prevention and Education (SHAPE) Task Force from the Society for Heart Attack Prevention and Eradication (SHAPE) has proposed a new strategy that recommends screening for subclinical atherosclerosis and implementing aggressive treatment of “vulnerable patients”. The Task Force has also envisioned future developments that may shift mass screening strategies to mass prophylactic therapy. The “Polypill” concept, introduced by Wald and Law, suggests that a combination of statin, low-dose anti-hypertensive, aspirin and folic acid in a single pill taken prophylactically by a high risk population can cut CVD event rates by as much as 80%. In this communication, we review the challenges and promises of such a strategy. “Polypill” is but one of an almost infinite number of possible multiconstituent pills (MCCP). The MCCP concept, although attractive, lacks evidence from randomized controlled trials. The following need to be addressed: credibility of the concept, design and synthesis of such complex pills, pharmacokinetics, pharmacodynamics, bioequivalence, “class” vs. unique properties, interactions, clinical efficacy and safety, regulatory approval, post-marketing surveillance, prescription vs. over-the- counter use, responsibility for initiating and monitoring therapy, patient education, counterfeiting and importation, reimbursement, advertisement, patent protection, and commercial viability. If these issues are favorably addressed, MCCP is poised to dramatically alter the face of CVD Prevention, particularly in developing societies. Universal adoption of highly effective, safe, and inexpensive MCCP has the potential to become a major public healthcare initiative in the movement for the worldwide eradication of heart Attacks. Nonetheless, in the absence of commercial interests, realizing the promise of MCCP will demand serious attention from national public health policymakers.
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From Vulnerable Plaque to Vulnerable Patient—Part III: Executive Summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force Report
The American Journal of Cardiology, 2006Co-Authors: Morteza Naghavi, Michael J. Jamieson, Harvey S. Hecht, Matthew J. Budoff, Erling Falk, Sanjay Kaul, Daniel S. Berman, Zahi A. Fayad, John A. Rumberger, Tasneem Z. NaqviAbstract:Screening for early-stage asymptomatic cancers (eg, cancers of breast and colon) to prevent late-stage malignancies has been widely accepted. However, although atherosclerotic cardiovascular disease (eg, heart Attack and stroke) accounts for more death and disability than all cancers combined, there are no national screening guidelines for asymptomatic (subclinical) atherosclerosis, and there is no governmentor healthcare-sponsored reimbursement for atherosclerosis screening. Part I and Part II of this consensus statement elaborated on new discoveries in the field of atherosclerosis that led to the concept of the “vulnerable patient.” These landmark discoveries, along with new diagnostic and therapeutic options, have set the stage for the next step: translation of this knowledge into a new practice of preventive cardiology. The identification and treatment of the vulnerable patient are the focuses of this consensus statement. In this report, the Screening for Heart Attack Prevention and Education (SHAPE) Task Force presents a new practice guideline for cardiovascular screening in the asymptomatic at-risk population. In summary, the SHAPE Guideline calls for noninvasive screening of all asymptomatic men 45‐75 years of age and asymptomatic women 55‐75 years of age (except those defined as very low risk) to detect and treat those with subclinical atherosclerosis. A variety of screening tests are available, and the cost-effectiveness of their use in a comprehensive strategy must be validated. Some of these screening tests, such as measurement of coronary artery calcification by computed tomography scanning and carotid artery intima‐media thickness and plaque by ultrasonography, have been available longer than others and are capable of providing direct evidence for the presence and extent of atherosclerosis. Both of these imaging methods provide prognostic information of proven value regarding the future risk of heart Attack and stroke. Careful and responsible implementation of these tests as part of a comprehensive risk assessment and reduction approach is warranted and outlined by this report. Other tests for the detection of atherosclerosis and abnormal arterial structure and function, such as magnetic resonance imaging of the great arteries, studies of small and large artery stiffness, and assessment of systemic endothelial dysfunction, are emerging and must be further validated. The screening results (severity of subclinical arterial disease) combined with risk factor assessment are used for risk stratification to identify the vulnerable patient and initiate appropriate therapy. The higher the risk, the more vulnerable an individual is to a near-term adverse event. Because
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from vulnerable plaque to vulnerable patient part iii executive summary of the screening for heart Attack Prevention and education shape task force report
American Journal of Cardiology, 2006Co-Authors: Morteza Naghavi, Michael J. Jamieson, Harvey S. Hecht, Matthew J. Budoff, Erling Falk, Sanjay Kaul, Daniel S. Berman, Zahi A. Fayad, John A. Rumberger, Tasneem Z. NaqviAbstract:Screening for early-stage asymptomatic cancers (eg, cancers of breast and colon) to prevent late-stage malignancies has been widely accepted. However, although atherosclerotic cardiovascular disease (eg, heart Attack and stroke) accounts for more death and disability than all cancers combined, there are no national screening guidelines for asymptomatic (subclinical) atherosclerosis, and there is no governmentor healthcare-sponsored reimbursement for atherosclerosis screening. Part I and Part II of this consensus statement elaborated on new discoveries in the field of atherosclerosis that led to the concept of the “vulnerable patient.” These landmark discoveries, along with new diagnostic and therapeutic options, have set the stage for the next step: translation of this knowledge into a new practice of preventive cardiology. The identification and treatment of the vulnerable patient are the focuses of this consensus statement. In this report, the Screening for Heart Attack Prevention and Education (SHAPE) Task Force presents a new practice guideline for cardiovascular screening in the asymptomatic at-risk population. In summary, the SHAPE Guideline calls for noninvasive screening of all asymptomatic men 45‐75 years of age and asymptomatic women 55‐75 years of age (except those defined as very low risk) to detect and treat those with subclinical atherosclerosis. A variety of screening tests are available, and the cost-effectiveness of their use in a comprehensive strategy must be validated. Some of these screening tests, such as measurement of coronary artery calcification by computed tomography scanning and carotid artery intima‐media thickness and plaque by ultrasonography, have been available longer than others and are capable of providing direct evidence for the presence and extent of atherosclerosis. Both of these imaging methods provide prognostic information of proven value regarding the future risk of heart Attack and stroke. Careful and responsible implementation of these tests as part of a comprehensive risk assessment and reduction approach is warranted and outlined by this report. Other tests for the detection of atherosclerosis and abnormal arterial structure and function, such as magnetic resonance imaging of the great arteries, studies of small and large artery stiffness, and assessment of systemic endothelial dysfunction, are emerging and must be further validated. The screening results (severity of subclinical arterial disease) combined with risk factor assessment are used for risk stratification to identify the vulnerable patient and initiate appropriate therapy. The higher the risk, the more vulnerable an individual is to a near-term adverse event. Because <10% of the population who test positive for atherosclerosis will experience a near-term event, additional risk stratification based on reliable markers of disease activity is needed and is expected to further focus the search for the vulnerable patient in the future. All individuals with asymptomatic atherosclerosis should be counseled and treated to prevent progression to overt
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From vulnerable plaque to vulnerable patient--Part III: Executive summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force report.
The American journal of cardiology, 2006Co-Authors: Morteza Naghavi, Michael J. Jamieson, Harvey S. Hecht, Matthew J. Budoff, Erling Falk, Sanjay Kaul, John A. Rumberger, Daniel Berman, Zahi Fayad, Tasneem Z. NaqviAbstract:Screening for early-stage asymptomatic cancers (eg, cancers of breast and colon) to prevent late-stage malignancies has been widely accepted. However, although atherosclerotic cardiovascular disease (eg, heart Attack and stroke) accounts for more death and disability than all cancers combined, there are no national screening guidelines for asymptomatic (subclinical) atherosclerosis, and there is no government- or healthcare-sponsored reimbursement for atherosclerosis screening. Part I and Part II of this consensus statement elaborated on new discoveries in the field of atherosclerosis that led to the concept of the "vulnerable patient." These landmark discoveries, along with new diagnostic and therapeutic options, have set the stage for the next step: translation of this knowledge into a new practice of preventive cardiology. The identification and treatment of the vulnerable patient are the focuses of this consensus statement. In this report, the Screening for Heart Attack Prevention and Education (SHAPE) Task Force presents a new practice guideline for cardiovascular screening in the asymptomatic at-risk population. In summary, the SHAPE Guideline calls for noninvasive screening of all asymptomatic men 45-75 years of age and asymptomatic women 55-75 years of age (except those defined as very low risk) to detect and treat those with subclinical atherosclerosis. A variety of screening tests are available, and the cost-effectiveness of their use in a comprehensive strategy must be validated. Some of these screening tests, such as measurement of coronary artery calcification by computed tomography scanning and carotid artery intima-media thickness and plaque by ultrasonography, have been available longer than others and are capable of providing direct evidence for the presence and extent of atherosclerosis. Both of these imaging methods provide prognostic information of proven value regarding the future risk of heart Attack and stroke. Careful and responsible implementation of these tests as part of a comprehensive risk assessment and reduction approach is warranted and outlined by this report. Other tests for the detection of atherosclerosis and abnormal arterial structure and function, such as magnetic resonance imaging of the great arteries, studies of small and large artery stiffness, and assessment of systemic endothelial dysfunction, are emerging and must be further validated. The screening results (severity of subclinical arterial disease) combined with risk factor assessment are used for risk stratification to identify the vulnerable patient and initiate appropriate therapy. The higher the risk, the more vulnerable an individual is to a near-term adverse event. Because
Harvey S. Hecht - One of the best experts on this subject based on the ideXlab platform.
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The Multiconstituent Cardiovascular Pill (MCCP): Challenges and Promises of Population Based Prophylactic Drug Therapy for Heart Attack Prevention and Eradication
Asymptomatic Atherosclerosis, 2010Co-Authors: Michael J. Jamieson, Harvey S. Hecht, Morteza NaghaviAbstract:Risk factors for atherosclerotic cardiovascular disease (CVD) are highly coprevalent but have been poorly identified and treated. The Screening for Heart Attack Prevention and Education (SHAPE) Task Force from the Society for Heart Attack Prevention and Eradication (SHAPE) has proposed a new strategy that recommends screening for subclinical atherosclerosis and implementing aggressive treatment of “vulnerable patients”. The Task Force has also envisioned future developments that may shift mass screening strategies to mass prophylactic therapy. The “Polypill” concept, introduced by Wald and Law, suggests that a combination of statin, low-dose anti-hypertensive, aspirin and folic acid in a single pill taken prophylactically by a high risk population can cut CVD event rates by as much as 80%. In this communication, we review the challenges and promises of such a strategy. “Polypill” is but one of an almost infinite number of possible multiconstituent pills (MCCP). The MCCP concept, although attractive, lacks evidence from randomized controlled trials. The following need to be addressed: credibility of the concept, design and synthesis of such complex pills, pharmacokinetics, pharmacodynamics, bioequivalence, “class” vs. unique properties, interactions, clinical efficacy and safety, regulatory approval, post-marketing surveillance, prescription vs. over-the- counter use, responsibility for initiating and monitoring therapy, patient education, counterfeiting and importation, reimbursement, advertisement, patent protection, and commercial viability. If these issues are favorably addressed, MCCP is poised to dramatically alter the face of CVD Prevention, particularly in developing societies. Universal adoption of highly effective, safe, and inexpensive MCCP has the potential to become a major public healthcare initiative in the movement for the worldwide eradication of heart Attacks. Nonetheless, in the absence of commercial interests, realizing the promise of MCCP will demand serious attention from national public health policymakers.
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From Vulnerable Plaque to Vulnerable Patient—Part III: Executive Summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force Report
The American Journal of Cardiology, 2006Co-Authors: Morteza Naghavi, Michael J. Jamieson, Harvey S. Hecht, Matthew J. Budoff, Erling Falk, Sanjay Kaul, Daniel S. Berman, Zahi A. Fayad, John A. Rumberger, Tasneem Z. NaqviAbstract:Screening for early-stage asymptomatic cancers (eg, cancers of breast and colon) to prevent late-stage malignancies has been widely accepted. However, although atherosclerotic cardiovascular disease (eg, heart Attack and stroke) accounts for more death and disability than all cancers combined, there are no national screening guidelines for asymptomatic (subclinical) atherosclerosis, and there is no governmentor healthcare-sponsored reimbursement for atherosclerosis screening. Part I and Part II of this consensus statement elaborated on new discoveries in the field of atherosclerosis that led to the concept of the “vulnerable patient.” These landmark discoveries, along with new diagnostic and therapeutic options, have set the stage for the next step: translation of this knowledge into a new practice of preventive cardiology. The identification and treatment of the vulnerable patient are the focuses of this consensus statement. In this report, the Screening for Heart Attack Prevention and Education (SHAPE) Task Force presents a new practice guideline for cardiovascular screening in the asymptomatic at-risk population. In summary, the SHAPE Guideline calls for noninvasive screening of all asymptomatic men 45‐75 years of age and asymptomatic women 55‐75 years of age (except those defined as very low risk) to detect and treat those with subclinical atherosclerosis. A variety of screening tests are available, and the cost-effectiveness of their use in a comprehensive strategy must be validated. Some of these screening tests, such as measurement of coronary artery calcification by computed tomography scanning and carotid artery intima‐media thickness and plaque by ultrasonography, have been available longer than others and are capable of providing direct evidence for the presence and extent of atherosclerosis. Both of these imaging methods provide prognostic information of proven value regarding the future risk of heart Attack and stroke. Careful and responsible implementation of these tests as part of a comprehensive risk assessment and reduction approach is warranted and outlined by this report. Other tests for the detection of atherosclerosis and abnormal arterial structure and function, such as magnetic resonance imaging of the great arteries, studies of small and large artery stiffness, and assessment of systemic endothelial dysfunction, are emerging and must be further validated. The screening results (severity of subclinical arterial disease) combined with risk factor assessment are used for risk stratification to identify the vulnerable patient and initiate appropriate therapy. The higher the risk, the more vulnerable an individual is to a near-term adverse event. Because
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from vulnerable plaque to vulnerable patient part iii executive summary of the screening for heart Attack Prevention and education shape task force report
American Journal of Cardiology, 2006Co-Authors: Morteza Naghavi, Michael J. Jamieson, Harvey S. Hecht, Matthew J. Budoff, Erling Falk, Sanjay Kaul, Daniel S. Berman, Zahi A. Fayad, John A. Rumberger, Tasneem Z. NaqviAbstract:Screening for early-stage asymptomatic cancers (eg, cancers of breast and colon) to prevent late-stage malignancies has been widely accepted. However, although atherosclerotic cardiovascular disease (eg, heart Attack and stroke) accounts for more death and disability than all cancers combined, there are no national screening guidelines for asymptomatic (subclinical) atherosclerosis, and there is no governmentor healthcare-sponsored reimbursement for atherosclerosis screening. Part I and Part II of this consensus statement elaborated on new discoveries in the field of atherosclerosis that led to the concept of the “vulnerable patient.” These landmark discoveries, along with new diagnostic and therapeutic options, have set the stage for the next step: translation of this knowledge into a new practice of preventive cardiology. The identification and treatment of the vulnerable patient are the focuses of this consensus statement. In this report, the Screening for Heart Attack Prevention and Education (SHAPE) Task Force presents a new practice guideline for cardiovascular screening in the asymptomatic at-risk population. In summary, the SHAPE Guideline calls for noninvasive screening of all asymptomatic men 45‐75 years of age and asymptomatic women 55‐75 years of age (except those defined as very low risk) to detect and treat those with subclinical atherosclerosis. A variety of screening tests are available, and the cost-effectiveness of their use in a comprehensive strategy must be validated. Some of these screening tests, such as measurement of coronary artery calcification by computed tomography scanning and carotid artery intima‐media thickness and plaque by ultrasonography, have been available longer than others and are capable of providing direct evidence for the presence and extent of atherosclerosis. Both of these imaging methods provide prognostic information of proven value regarding the future risk of heart Attack and stroke. Careful and responsible implementation of these tests as part of a comprehensive risk assessment and reduction approach is warranted and outlined by this report. Other tests for the detection of atherosclerosis and abnormal arterial structure and function, such as magnetic resonance imaging of the great arteries, studies of small and large artery stiffness, and assessment of systemic endothelial dysfunction, are emerging and must be further validated. The screening results (severity of subclinical arterial disease) combined with risk factor assessment are used for risk stratification to identify the vulnerable patient and initiate appropriate therapy. The higher the risk, the more vulnerable an individual is to a near-term adverse event. Because <10% of the population who test positive for atherosclerosis will experience a near-term event, additional risk stratification based on reliable markers of disease activity is needed and is expected to further focus the search for the vulnerable patient in the future. All individuals with asymptomatic atherosclerosis should be counseled and treated to prevent progression to overt
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From vulnerable plaque to vulnerable patient--Part III: Executive summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force report.
The American journal of cardiology, 2006Co-Authors: Morteza Naghavi, Michael J. Jamieson, Harvey S. Hecht, Matthew J. Budoff, Erling Falk, Sanjay Kaul, John A. Rumberger, Daniel Berman, Zahi Fayad, Tasneem Z. NaqviAbstract:Screening for early-stage asymptomatic cancers (eg, cancers of breast and colon) to prevent late-stage malignancies has been widely accepted. However, although atherosclerotic cardiovascular disease (eg, heart Attack and stroke) accounts for more death and disability than all cancers combined, there are no national screening guidelines for asymptomatic (subclinical) atherosclerosis, and there is no government- or healthcare-sponsored reimbursement for atherosclerosis screening. Part I and Part II of this consensus statement elaborated on new discoveries in the field of atherosclerosis that led to the concept of the "vulnerable patient." These landmark discoveries, along with new diagnostic and therapeutic options, have set the stage for the next step: translation of this knowledge into a new practice of preventive cardiology. The identification and treatment of the vulnerable patient are the focuses of this consensus statement. In this report, the Screening for Heart Attack Prevention and Education (SHAPE) Task Force presents a new practice guideline for cardiovascular screening in the asymptomatic at-risk population. In summary, the SHAPE Guideline calls for noninvasive screening of all asymptomatic men 45-75 years of age and asymptomatic women 55-75 years of age (except those defined as very low risk) to detect and treat those with subclinical atherosclerosis. A variety of screening tests are available, and the cost-effectiveness of their use in a comprehensive strategy must be validated. Some of these screening tests, such as measurement of coronary artery calcification by computed tomography scanning and carotid artery intima-media thickness and plaque by ultrasonography, have been available longer than others and are capable of providing direct evidence for the presence and extent of atherosclerosis. Both of these imaging methods provide prognostic information of proven value regarding the future risk of heart Attack and stroke. Careful and responsible implementation of these tests as part of a comprehensive risk assessment and reduction approach is warranted and outlined by this report. Other tests for the detection of atherosclerosis and abnormal arterial structure and function, such as magnetic resonance imaging of the great arteries, studies of small and large artery stiffness, and assessment of systemic endothelial dysfunction, are emerging and must be further validated. The screening results (severity of subclinical arterial disease) combined with risk factor assessment are used for risk stratification to identify the vulnerable patient and initiate appropriate therapy. The higher the risk, the more vulnerable an individual is to a near-term adverse event. Because