Insufficient evidence that Non-Traditional cardiac tests are necessary

Finds “Insufficient” Evidence that Non-traditional Cardiac Tests Are Necessary

Cardiovascular diseases (CVD) is caused by plaque that builds up in the blood vessels. This plaque can potentially create blockages in the arteries that lead to the heart, brain, or legs, resulting in heart attacks, stroke, or even death.

Certain individuals are more at risk of CVD, and the risk increases with age. In addition to age, smoking, high blood pressure, diabetes, high cholesterol, obesity, and family history are all factors that doctors have traditionally looked at when assessing patient risk for CVD.

According to the Center for Disease Control (CDC), heart disease causes 1 of every 4 deaths in the U.S.  Because CVD is such a serious and prevalent problem, doctors began adding nontraditional risk factor assessments in adults who show no symptoms of CVD.  These included:

• Ankle-brachial index (ABI): This is a calculation that compares the blood pressure values taken at the ankle and at the arm. A low ABI number may indicate that there’s a blockage or narrowing of the arteries, reducing blood flow in the legs.
• High-sensitivity C-reactive protein (hsCRP): For this test, blood is drawn to measure the protein level in blood. A high CRP level indicates there is an infection or inflammation in the body. However, the test cannot indicate whether the inflammation is from heart disease or from something else, such as arthritis.
• Coronary artery calcium (CAC) score: This is the most invasive of the tests, using a CAT scan of the chest to measure how much calcium is in the heart’s blood vessels. The test looks for calcified plaque in the arteries surrounding the heart.

The goal for adding these nontraditional risk factor screenings was to catch the cardiovascular disease in more individuals, in turn reducing the number of heart attacks, strokes, and death in those who otherwise showed no CVD symptoms. However, so far there is little evidence that adding these three nontraditional screenings have actually done much good, at least in those with no other symptoms. They may be beneficial for those with a moderate risk of heart disease.

Given the lack of evidence that the nontraditional screenings are helping prevent heart attacks and strokes, the new question is are they really necessary? The CAC test, in particular, is the most invasive, as it provides a low-dose of radiation – about the same amount as a mammogram. Additionally, these tests are not always covered by insurance.

As a result, the U.S. Preventive Services Task Force has recently published recommendations about these additional tests. Specifically, the USPSTF concluded that “the current evidence is insufficient to assess the balance of benefits and harms of adding the ankle-brachial index (ABI), high-sensitivity C-reactive protein (hsCRP) level, or coronary artery calcium (CAC) score to traditional risk assessment for cardiovascular disease (CVD) in asymptomatic adults to prevent CVD events.”