Compelling reasons not to routinely screen those without symptoms for heart disease
October 18, 2023
Many people would like to know if they have heart disease, and low dose CT scans can produce a “calcium score” that estimates the likelihood an individual has heart disease.
But screening can lead to false positives, or the person screened could find something that is worrisome but where an intervention might not help. Worse still, sometimes well-meaning interventions to help decrease risk can hurt people. For example, screening for thyroid cancer in South Korea found many cases of cancer and led to many undergoing potentially dangerous surgery, but did not decrease deaths from cancer because almost all of the newly-found cancer was a type of cancer that poses only a small risk.
Researchers in JAMA Internal Medicine evaluated the results of CT scans to determine frequency of findings of calcium in the coronary arteries that serve the heart, an indication of likely coronary artery disease. They found positive calcium scores in many people with no symptoms, including a majority of white men over 50. This test alone is not a good indication of true cardiovascular risk and may lead to additional tests or unnecessary treatment of some individuals.
Prevalence of detectable coronary artery calcium on Chest CT scan
Source:Tattersol, et al JAMA Int Med October, 2023 LINK
Implications for employers:
Follow health insurance carrier guidelines regarding testing appropriateness, and don’t provide members who have no symptoms of heart disease with coverage for non-evidence-based screening tests such as calcium scores.
Employers can focus their efforts to reduce cardiovascular disease on evidence-based approaches to decrease risk factors of smoking, diabetes, hypertension, high cholesterol and obesity, as noted above.
This is another reason to be cautious of executive physicals, which often include non-evidence-based screening tests.
Those with exertional chest pain or other signs of coronary disease should seek medical attention - not a screening test!
All patients, regardless of their calcium score, benefit from risk reduction.
Tomorrow: Disparities in kidney transplants
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