February 21, 2012

Heart healthy skepticism

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On the USA Today website, Liz Szabo interviews cardiology experts Marc Gillinov and Steven Nissen of the Cleveland Clinic, authors of the new book, Heart 411: The Only Guide to Heart Health You’ll Ever Need. In the piece, Gillinov and Nissen say:

We suggest avoiding these tests:

Heart calcium scans. These tests expose patients to excessive radiation and have not been demonstrated to save lives.

Total body CT scans. These scans, which examine the heart and other organs throughout the body, involve huge doses of radiation and have not been shown to improve outcomes. The Food and Drug Administration has warned the public about this procedure.

Exercise stress tests, or treadmill tests, in patients without symptoms. The chances of a false positive test are high and an abnormal often leads to unnecessary heart catheterization, an invasive procedure in which long tubes are inserted through the blood vessels.

Some ultrasound examinations (echo tests). These should not be performed in healthy individuals and should be used only for those with other signs of heart disease, such as a heart murmur or heart failure. An echocardiogram, or ultrasound of the heart, should be used only for those with other signs of heart disease, such as a heart murmur or heart failure. Carotid ultrasounds, for example, are sometimes ordered in healthy people to determine if they have thickened walls of the artery. The problem with this type of screening test is that it can lead to unintended consequences. We strongly prefer to get a medical history, then measure the well-validated risk factors such as cholesterol and blood pressure.

Fancy cholesterol tests. Well-meaning physicians frequently order special cholesterol tests that measure cholesterol “particle size,” sometimes known as VAP or NMR cholesterol tests. These tests are expensive and do not improve outcomes. They are unnecessary.

Comments (2)

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Paul Scott

February 23, 2012 at 7:09 pm

Small particle tests may not be warranted for the general population but they likely offer more meaningful information than an LDL test.

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