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Heart Tests Not for Everyone

Panel says low-risk people without symptoms don't need them

WEDNESDAY, Feb. 18 , 2004 (HealthDayNews) -- A federal task force now says that three tests commonly used to detect heart trouble are not recommended for people at low risk for cardiovascular problems who aren't showing any signs of disease.

New guidelines for the tests -- treadmills, resting electrocardiograms (EKGs) and electron beam computerized tomography scans for coronary calcium -- appear in the Feb. 17 issue of the Annals of Internal Medicine. The new recommendations, by the U.S. Preventive Services Task Force, replace ones issued in 1996.

"If you are a low-risk adult with no symptoms, there is really no reason to experience these tests," says Dr. Ned Calonge, the task force chairman. "We do not recommend them because of the risk of false positives."

Calonge, chief medical officer and state epidemiologist for the Colorado Department of Public Health and Environment, says that false-positive results usually lead to further invasive tests such as coronary angiography or treatment with unnecessary medications.

The task force defines those generally considered at low risk for heart disease as men under age 50 and women under age 60 who have normal blood pressure and cholesterol levels, do not smoke and do not have diabetes.

Even for adults at increased risk for heart disease, the task force found insufficient evidence for or against using these three tests for screening.

Under the 1996 recommendations, the task force had said there was insufficient evidence for screening low-risk adults and for those at increased risk, explains Dr. Paul Frame, a member of the task force and a clinical professor of family medicine at the University of Rochester School of Medicine and Dentistry in New York.

So, the new recommendations reflect a stronger stance against screening those at low risk, Frame says.

Electron beam scanning was not evaluated in the 1996 guidelines.

An estimated 22 million Americans have heart disease, according to the task force, and more than 700,000 die from it annually.

An exercise stress test gives a general idea of how healthy your heart is. While you walk on a treadmill or pedal a stationary bike, the electrical activity of your heart is measured, as is your heart's reaction to your body's increased demand for oxygen.

A resting electrocardiogram records electric currents produced by the heart, and an electron beam computerized tomography scan is an imaging procedure that can detect blocked or clogged arteries.

The new guidelines make sense to Dr. Victor Froelicher, director of the EKG and exercise lab at the VA Medical Center in Palo Alto, Calif.

"This guideline now includes one of the newest screening tools [electron beam scans], which in consensus has been agreed on to offer no additional benefit in a low-risk population," he says.

More information

For a summary of the new recommendations, visit U.S. Preventive Services Task Force. For a calculator to estimate risk of heart disease, check out the National Heart, Lung, and Blood Institute.

SOURCES: Victor Froelicher, M.D., cardiologist and professor, medicine, Stanford University School of Medicine, Stanford, Calif.; Ned Calonge, M.D., chairman, U.S. Preventive Services Task Force, and chief medical officer and state epidemiologist, Colorado Department of Public Health and Environment; Paul Frame, M.D., clinical professor, family medicine, University of Rochester School of Medicine and Dentistry, Rochester, N.Y., and task force member; Feb. 17, 2004, Annals of Internal Medicine
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