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,
Frederick Hecht, M.D.
Medical Editors, MedicineNet.com
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),
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
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