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Making smart screening decisions: Part 3: Cardiac screening tests

Learn which heart screening tests you need, and which ones aren’t worth the cost.

With about five times as many women dying from heart attacks as from breast cancer, cardiac screening should feature prominently on our list of health concerns. Even so, we don’t necessarily need to have every cardiac screening test that’s available to us. Dr. Loryn Feinberg, director of the Women’s Cardiovascular Program at Beth Israel Deaconess Medical Center, explains which tests we need—and which ones could expose us to unnecessary risks.

Do healthy women over age 50 with no obvious heart disease risks need routine cardiac screening?

Guidelines from the American College of Cardiology, American Heart Association, and U.S. Preventive Services Task Force do not recommend screening EKGs or other routine imaging tests in women who do not have heart disease risk factors such as diabetes, high blood pressure, obesity, or smoking. If you develop symptoms of heart disease, then you may need testing.

How do I know whether I’d benefit from having screning tests beyond routine blood tests?

Screening tests such as an EKG or stress test are mostly beneficial in patients with symptoms of heart disease, or who are at risk for diseases that may not have symptoms, such as diabetes. If you are at a higher risk for heart disease because of your own personal risk factors or a strong family history of heart disease, ask your doctor if you need to undergo a full risk assessment and discuss whether you need further testing.

What are the risks of over-screening for heart disease?

One of the risks that comes with doing unnecessary testing is that you are much more likely to have a high false-positive rate. In other words, there is a higher likelihood that a test will indicate a disease when it does not actually exist. That will lead to further testing and treatments, which could have adverse effects. It can also lead to unnecessary worry and stress about your health, not to mention higher health care costs. Some screening tests, such as calcium scoring, expose the chest to radiation, which can slightly increase the risk for breast and other cancers over time, especially with repeated exposures.

If my doctor recommends a cardiac screening test, what questions should I ask?

Patients need to be knowledgeable about what’s being done and why, and not just have tests because they are available. When a screening test is offered, ask why this test is being done, how it will benefit you, how it will change how the doctor manages you, and whether there are any risks involved.

What tests do all women need to have, even if they’re not at high risk for heart disease?

Most women over the age of 50 who are healthy need to have some basic tests done by their primary care provider at their annual visit. You need to have your fasting glucose (blood sugar) or hemoglobin A1C (a measurement of the average blood sugar reading over three months) levels tested to check for diabetes. Blood pressure should be checked, as well as fasting cholesterol levels, which includes total cholesterol, HDL (“good” cholesterol), LDL (“bad” cholesterol), and triglycerides. Your doctor should also check your body mass index (BMI)—which is easy to calculate using height and weight—and waist circumference to screen for obesity. Some of the measurements from these tests are put into a global risk assessment, such as the Framingham Risk Score or Reynolds Risk Score. These scores can be used to calculate your 10-year or lifetime risk of developing heart disease or cardiovascular disease (which includes stroke, coronary artery disease, and peripheral arterial disease).

Heart screening tests

  • Electrocardiogram (ECG or EKG)—a test that checks the electrical activity of the heart to detect problems such as an irregular heart rhythm or heart attack.

  • Echocardiogram—a test that uses sound waves to show how well the heart is beating and pumping blood, and to evaluate the heart valves and chambers.

  • Stress test—a test in which you walk on a treadmill or pedal a stationary bike to see how well your heart functions under physical stress, and to test whether you have severe coronary artery disease or exercise-induced heart rhythm problems.

  • CT angiography—an imaging test that uses x-rays to look for narrowing in the coronary arteries.

  • Abdominal aortic aneurysm screening—an ultrasound that checks for a weak, bulging area in the major blood vessel that supplies blood to the lower body.

  • Coronary calcium scoring—a scan that uses x-rays to look for the buildup of calcium (calcifications) in the walls of the coronary arteries, which is an early sign of heart disease.

Posted by: Dr.Health

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