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VIEWPOINT AND COMMENTARY

Defining a Rational Approach to Screening for Cardiovascular Risk in Asymptomatic Patients

Departments of Preventive Medicine and Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.

Manuscript received March 31, 2008; revised manuscript received April 15, 2008, accepted April 21, 2008.

^_* Reprint requests and correspondence: Dr. Philip Greenland, Northwestern University, Feinberg School of Medicine, 750 North Lake Shore Drive, 9th Floor, Chicago, Illinois 60611.

Screening for coronary artery disease or for other forms of cardiovascular disease (CVD), is a superficially attractive idea that has been proposed by many cardiovascular experts. However, guidelines panels that employ medical outcomes and evaluation of a full range of benefits, risks, and harms of screening have repeatedly advised against the adoption of screening programs for CVDs. In this commentary, we discuss the limitations of the predictive capacity of selected cardiovascular screening tools. Possible harms and risks of screening tools are also discussed, and the conclusion is reached that available evidence does not provide support for adoption of a strategy of routine screening of asymptomatic people for CVD with available testing tools or devices. More evidence is needed to justify a policy of screening for CVD.

Key Words: atherosclerosis • imaging • screening

Abbreviations and Acronyms   CAC = coronary artery calcium   CAD = coronary artery disease   CHD = coronary heart disease   CVD = cardiovascular disease