Low-risk patients screened for heart disease tend to receive more preventive care and testing

May 23, 2011

Screening for coronary heart disease (CHD) among individuals at low risk of the condition is associated with increased use of medications (such as aspirin and statins) and increased additional testing, but no difference in cardiac events at 18 months, according to a report posted online today that will be published in the August 8 print issue of Archives of Internal Medicine, one of the JAMA/Archives journals. The article is part of the journal's Less Is More series.

Coronary heart disease is associated with atherosclerosis, a process in which plaque builds up in the lining of the arteries. More than half of deaths attributed to CHD occur in people who have no signs of heart trouble, according to background information in the article. Coronary computed tomographic angiography (CCTA), a test that uses X-rays to provide a clear look at the heart and arteries, has been suggested as a tool for screening low-risk patients for CHD. "Given the potential for more widespread use of CCTA in cardiac risk evaluation, we sought to evaluate the downstream implications of CCTA testing," write the authors.

John W. McEvoy, M.B., B.Ch., B.A.O., M.R.C.P.I., from Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, and colleagues studied the effect of CCTA in patients who were not at high risk for CHD. From a health screening program conducted at Seoul National University Bundang Hospital in Seoul, South Korea, they selected 1,000 patients who had chosen to undergo CCTA testing and 1,000 patients who did not; neither group had CHD symptoms. At three months and 18 months later, the researchers examined medication use, secondary test referrals, surgical restoration of the blood supply (revascularization) and cardiovascular incidents.

Among the group that had been screened, 215 patients (21 percent) tested positive for signs of atherosclerosis. Those patients were more likely to receive prescriptions for medication at the initial visit and subsequently more likely to undergo further testing and take aspirin and cholesterol-lowering statin drugs during the follow-up period. Patients who had been screened by CCTA were more likely to undergo revascularization, but not to experience cardiovascular events; by 18 months, one such incident had occurred in both the screened and the unscreened groups.

The authors concluded that "physicians and patients may dramatically change practice based on CCTA findings," and call for further study of the implications of this shift, especially in patients at higher risk of CHD. They also point out that the increase in preventive interventions in patients with positive CCTA results did not appear to significantly reduce the risk of cardiovascular incidents, when compared with patients who did not undergo CCTA testing. "Thus," they conclude, "the potential benefit of increased medication use in the CCTA group is tempered by the risk of further testing in low-risk patients without any evidence-based indication."

(Arch Intern Med. 2011;10.1001/archinternmed.2011.204. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Commentary: The Relative Merits of Screening Low-Risk Populations for CHD

The study provides a much-needed perspective of the value of widespread screening versus the risk of diagnosing conditions in people who might never go on to develop illness, according to Michael S. Lauer, M.D., from the National Heart, Lung, and Blood Institute, Bethesda, Md. "Overdiagnosis is a serious problem because it leads to a number of harms, while by its very nature it cannot offer benefit," he writes in commentary accompanying the article. "Physicians cannot easily ignore diagnoses made with screening tests because it is impossible for them to determine whether their patients have real disease or pseudodisease." Lauer urges large-scale trials to determine which groups are at highest risk for health problems, as those individuals would be most likely to benefit from screening. "Given the high prevalence and fears associated with coronary heart disease, the stakes could not be higher," he says.
(Arch Intern Med. 2011;10.1001/archinternmed.2011.205. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.To contact corresponding author Hyuk-Jae Chang, M.D., Ph.D., e-mail ross1042@gmail.com. To contact lead author John W. McEvoy, M.B., B.Ch., B.A.O., M.R.C.P.I., call Ellen Beth Levitt at 410-955-5307 or e-mail eblevitt@jhmi.edu.

To contact Michael S. Lauer, M.D., call the National Heart, Lung, and Blood Institute Communications Office at 301-496-4236 or e-mail nhlbi_news@nhlbi.nih.gov.

The JAMA Network Journals

Related Heart Disease Articles from Brightsurf:

Cellular pathway of genetic heart disease similar to neurodegenerative disease
Research on a genetic heart disease has uncovered a new and unexpected mechanism for heart failure.

Mechanism linking gum disease to heart disease, other inflammatory conditions discovered
The link between periodontal (gum) disease and other inflammatory conditions such as heart disease and diabetes has long been established, but the mechanism behind that association has, until now, remained a mystery.

New 'atlas' of human heart cells first step toward precision treatments for heart disease
Scientists have for the first time documented all of the different cell types and genes expressed in the healthy human heart, in research published in the journal Nature.

With a heavy heart: How men and women develop heart disease differently
A new study by researchers from McGill University has uncovered that minerals causing aortic heart valve blockage in men and women are different, a discovery that could change how heart disease is diagnosed and treated.

Heart-healthy diets are naturally low in dietary cholesterol and can help to reduce the risk of heart disease and stroke
Eating a heart-healthy dietary pattern rich in vegetables, fruits, whole grains, low-fat dairy products, poultry, fish, legumes, vegetable oils and nuts, which is also limits salt, red and processed meats, refined-carbohydrates and added sugars, is relatively low in dietary cholesterol and supports healthy levels of artery-clogging LDL cholesterol.

Pacemakers can improve heart function in patients with chemotherapy-induced heart disease
Research has shown that treating chemotherapy-induced cardiomyopathy with commercially available cardiac resynchronization therapy (CRT) delivered through a surgically implanted defibrillator or pacemaker can significantly improve patient outcomes.

Arsenic in drinking water may change heart structure raising risk of heart disease
Drinking water that is contaminated with arsenic may lead to thickening of the heart's main pumping chamber in young adults, according to a new study by researchers at Columbia University Mailman School of Public Health.

New health calculator can help predict heart disease risk, estimate heart age
A new online health calculator can help people determine their risk of heart disease, as well as their heart age, accounting for sociodemographic factors such as ethnicity, sense of belonging and education, as well as health status and lifestyle behaviors.

Wide variation in rate of death between VA hospitals for patients with heart disease, heart failure
Death rates for veterans with ischemic heart disease and chronic heart failure varied widely across the Veterans Affairs (VA) health care system from 2010 to 2014, which could suggest differences in the quality of cardiovascular health care provided by VA medical centers.

Heart failure: The Alzheimer's disease of the heart?
Similar to how protein clumps build up in the brain in people with some neurodegenerative diseases such as Alzheimer's and Parkinson's diseases, protein clumps appear to accumulate in the diseased hearts of mice and people with heart failure, according to a team led by Johns Hopkins University researchers.

Read More: Heart Disease News and Heart Disease Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.