The things to come of SHAPE: cost and effectiveness of cardiovascular prevention.

It has been proposed recently that asymptomatic adults undergo routine screening for subclinical atherosclerosis using electron-beam computed tomography or carotid ultrasound as the basis for the pharmacologic prevention of cardiovascular events. The expected cost and effectiveness of this conditional test-treatment strategy are herein analyzed in comparison with the conventional conditional strategy, based on Framingham risk factor assessment, and with an unconditional treatment strategy that does not rely on testing. These analyses show that the unconditional treatment strategy, albeit more costly, is more effective and more cost-effective than either conditional testing strategy. In conclusion, greater attention should be paid to improving the population-wide delivery of and long-term adherence to proven preventive therapy than to the identification of "high-risk" treatment targets.