This statement summarizes the gene...

This statement summarizes the generally received U.S. Preventive Services Task Force (USPSTF) recommendations forward screening for coronary heart disease and the supporting scientific evidence, and updates the 1996 recommendations contained in the Guide to Clinical Preventive Services, inferior Edition. (1) Explanations of the ratings and of the hardness of overall evidence are given in Tables 1 and 2 respectively. The clean information on which this statement is based, including evidence tables and hints is available in the summary article (2) and the systematic evidence review (3) in succession this topic, available through the USPSTF Web site (http://www.preventiveservices.ahrq.gov) and from one side the National Guideline Clearinghouse (http://www.guideline.gov). The summary article and the recommendation statement are also available from the Agency for Healthcare Research and Quality (AHRQ) Publications Clearinghouse in print by the and of subscription to the Guide to Clinical Preventive Services, third edition: Periodic Updates. To order, contact the clearinghouse at 800-358-9295 or e-mail ahrqpubs@ahrq.gov.

Recommendations made on the USPSTF are independent of the U rule They should not be constru as an official position of AHRQ or the U Department of Health and Human Services.

This recommendation first appeared in Ann Intern M 2004;140:569-72

Summary of Recommendations

* The USPSTF attract favor tos against routine screening with resting electrocardiography (ECG) exercise treadmill standard (ETT), or electron-beam computerized tomography (EBCT) scanning for coronary calcium for either the nearness of severe coronary artery stenosis (CAS) or the prediction of coronary heart disease (CHD) occurrences in adults at low risk for CHD terminations D recommendation.

The USPSTF erect at least fair evidence that ECG or ETT can find out some asymptomatic adults at increased risk for CHD adventures independent of conventional CHD risk factors (see Clinical Considerations), and that ETT can find out severe CAS in a small number of asymptomatic adults. Similar evidence for EBCT is limited. In the absence of evidence that as it is detection by ECG, ETT, or EBCT among adults at gentle risk for CHD events ultimately flows in improved health outcomes, and because false-positive examples are likely to cause harm, including unnecessary invasive deeds overtreatment, and labeling, the USPSTF conclud that the potential harms of routine screening for CHD in this population exce the potential benefits.

* The USPSTF ground insufficient evidence to recommend for or against routine screening with ECG ETT or EBCT scanning for coronary calcium for either the vicinity of severe CAS or the prediction of CHD ends in adults at increased risk for CHD adventures I recommendation.

The USPSTF establish inadequate evidence to determine the length to which the added detection propounded by ECG, ETT, or EBCT (beyond that obtained according to ascertainment of conventional CHD risk factors; behold Clinical Considerations) would result in interventions that lead to improved CHD-related health consequences among adults at increased risk for CHD facts Although there is limited evidence to determine the magnitude of harms from screening this population, harms from false-positive ordeals (i.e., unnecessary invasive procedures, overtreatment, and labeling) are likely to come into one's head As a result, the USPSTF could not determine the balance between benefits and harms of screening this population for CHD

Clinical Considerations

* Several factors are associated with a higher risk for CHD facts (the major ones are nonfatal myocardial infarction and coronary death), including older age, male inflection for sex high blood pressure, smoking, abnormal lipid horizontals diabetes, obesity, and sedentary lifestyle. A person's risk for CHD circumstances can be estimated based in succession the presence of these factors. Calculators are available to ascertain a person's risk for having a CHD event; for example, a calculator to estimate a person's risk for a CHD issue in the next 10 years can be accessed at http://hin.nhlbi.nih.gov/atpiii/ calculator.asp?usertype=prof. Although the exact risk factors that constitute each of these categories (low or increased risk) have not been established, younger adults (i.e., men younger than 50 years and women younger than 60 years) who have no other risk factors for CHD (les than 5 to 10 percent 10-year risk) are considered to be at gentle risk. Older adults, or younger adults with undivided or more risk factors (greater than 15 to 20 percent 10-year risk), are considered to be at increased risk.

* Screening with ECG ETT and EBCT potentially could lessen CHD events in two ways: according to detecting persons at high risk for CHD marked occurrences who could benefit from more aggressive risk factor modification or according to detecting persons with existing peremptory CAS whose life could be protracted by coronary artery bypass grafting (CABG) surgery.However, the evidence is inadequate to determine the size to which persons detected by the agency of screening in either situation would benefit from either mark of intervention.