To the Editor: In his Commentary, Mr. Jacobson¹ called on national medical societies to oppose proposed Texas legislation that would mandate that health insurers provide reimbursement for screening to detect atherosclerosis, indicating that it is based on a flawed concept and should be rejected because it lacks endorsement from the American Heart Association (AHA), the American College of Cardiology (ACC), or the European Society of Cardiology. The concept was introduced by the Society for Heart Attack Prevention and Education (SHAPE).² We believe that this Commentary contains several misunderstandings.

First, most initial myocardial infarctions occur in asymptomatic individuals with unrecognized atherosclerosis who are classified by the Framingham Risk Score as low or intermediate risk.3 Thus, when screening is based on risk factors alone, most individuals destined for a near-term myocardial infarction are not identified and, consequently, not offered adequate preventive treatment.

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