Heart Tests Not for Low Risk People

Background: Men under 50 and women under 60 who have normal blood pressure and cholesterol levels, do not smoke and do not have diabetes are generally considered at low risk for heart disease.

Summary: It has been recommended that people at low risk for heart disease not have routine screening with a resting electrocardiogram (ECG), a treadmill test, or a CT scan for coronary calcium.

Rationale: These recommendations were made by the U.S. Preventive Services Task Force which "concluded that the potential harms of routine screening" for coronary heart disease "exceed the potential benefits" in people with a low risk of heart disease. The "harms" come from an excessive proportion of false positive results that lead to invasive procedures such as cardiac catheterization and angiography and to unnecessary treatment with medications.

Note: The Summary of Recommendations (below) from the U.S. Preventive Services Task Force is somewhat technical.

Barbara K. Hecht, Ph.D.
Frederick Hecht, M.D.
Medical Editors, MedicineNet.com

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U.S. Preventive Services Task Force

Screening for Coronary Heart Disease

Release Date: February 2004

Summary of Recommendations

  • The U.S. Preventive Services Task Force (USPSTF) recommends against routine screening with resting electrocardiography (ECG), exercise treadmill test (ETT), or electron-beam computerized tomography (EBCT) scanning for coronary calcium for either the presence of severe coronary artery stenosis (CAS) or the prediction of coronary heart disease (CHD) events in adults at low risk for CHD events.

Rating: D recommendation (The USPSTF recommends against routinely providing [the service] to asymptomatic patients. The USPSTF found at least fair evidence that the service is ineffective or that harms outweigh benefits).

Rationale: The USPSTF found at least fair evidence that ECG or ETT can detect some asymptomatic adults at increased risk for CHD events independent of conventional CHD risk factors, and that ETT can detect severe CAS in a small number of asymptomatic adults. Similar evidence for EBCT is limited. In the absence of evidence that such detection by ECG, ETT, or EBCT among adults at low risk for CHD events ultimately results in improved health outcomes, and because false-positive tests are likely to cause harm, including unnecessary invasive procedures, over-treatment, and labeling, the USPSTF concluded that the potential harms of routine screening for CHD in this population exceed the potential benefits.

  • The USPSTF found insufficient evidence to recommend for or against routine screening with ECG, ETT, or EBCT scanning for coronary calcium for either the presence of severe CAS or the prediction of CHD events in adults at increased risk for CHD events.

Rating: I recommendation (The USPSTF concludes that the evidence is insufficient to recommend for or against routinely providing the service. Evidence that the service is effective is lacking, of poor quality, or conflicting and the balance of benefits and harms cannot be determined.)

Rationale: The USPSTF found inadequate evidence to determine the extent to which the added detection offered by ECG, ETT, or EBCT (beyond that obtained by ascertainment of conventional CHD risk factors) would result in interventions that lead to improved CHD-related health outcomes among adults at increased risk for CHD events. Although there is limited evidence to determine the magnitude of harms from screening this population, harms from false-positive tests (i.e., unnecessary invasive procedures, over-treatment, and labeling) are likely to occur. As a result, the USPSTF could not determine the balance between benefits and harms of screening this population for CHD.

Source: U.S. Preventive Services Task Force. Screening for Coronary Heart Disease. Summary of Recommendations. February 2004.


Last Editorial Review: 2/1/2005




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