Guidelines: Screening for Coronary Heart Disease

Sponsoring Organization: U.S. Preventive Services Task Force

Background and Purpose: The USPSTF has updated its 1996 recommendations for coronary heart disease (CHD) screening. The authors have reviewed the relevant scientific evidence to determine whether data on outcomes support supplementing conventional CHD risk assessment.

Key Points:

Clinicians should routinely ascertain an individual's overall risk for CHD events by screening for risk factors and by using that information with a risk-assessment tool such as Framingham scoring.
Asymptomatic adults benefit from risk-factor modification proportional to their degree of CHD risk.
The authors recommend against routine use of electrocardiography (ECG), exercise treadmill testing (ETT), and electron-beam computed tomography (EBCT) in low-risk adults (men younger than 50 and women younger than 60 with no established risk factors and 10-year Framingham risk for CHD <10%).
The authors write that there is insufficient evidence to recommend for or against routine ECG, ETT, and EBCT screening in adults with one or more established CHD risk factors and 10-year CHD risk >15% to 20%.
If a person's occupation is such that sudden incapacitation or death would endanger the safety of others, screening for CHD may be warranted (and sometimes is imperative), even when health benefits to the individual are not clear.

These brief guidelines highlight that for most asymptomatic, low-risk individuals, routine screening with ECG, ETT, or EBCT is not warranted, because the potential risks associated with false positives outweigh the potential benefits of screening. For intermediate-risk patients, the guideline authors do not take a position. In contrast, ACC-AHA guidelines are more detailed: For example, they recommend consideration of ETT for asymptomatic men age 45 or older and women age 55 or older who plan to start an exercise program or are at risk due to other vascular diseases, diabetes, or chronic kidney disease (Journal Watch Cardiology Nov 1 2002). (For sedentary patients starting an exercise program, the ACC-AHA guidelines provide no specific recommendations below the age 45/55 thresholds, but clinicians may wish to consider ETT and a clear exercise prescription in higher-risk patients.) The USPSTF and ACC-AHA guidelines both make allowances for patients with high-risk occupations. Overall, we have much to learn about the value of screening for improving outcomes in specific subgroups of asymptomatic patients.

 JoAnne M. Foody, MD

U.S. Preventive Services Task Force. Screening for coronary heart disease: Recommendation statement. Ann Intern Med 2004 Apr 6; 140:569-72.

Fowler-Brown A et al. Exercise tolerance testing to screen for coronary heart disease: A systematic review for the technical support for the U.S. Preventive Services Task Force. Ann Intern Med 2004 Apr 6; 140:W9-W24. (https://www.annals.org/cgi/content/full/140/7/W-9)

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Cite this: Guidelines: Screening for Coronary Heart Disease - Medscape - Apr 23, 2004.

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