Hardening of the arteries is the most deadly and disabling disease in the country.
When it occurs in your heart arteries, the disorder can lead to a heart attack. In the arteries of your neck and brain, it may progress to a stroke. And in blood vessels that supply your legs, it culminates in peripheral artery disease.
But because symptoms of each condition usually aren’t present in the early stages, people may not be aware of the risk until it’s too late. Oftentimes, a full-blown heart attack, stroke or arterial blockage of a limb is the first indication of the problem.
To address the need for a better warning system, a group of leading cardiologists has proposed a novel approach: Screening for hardening of the arteries before symptoms occur in the millions of Americans who may be at risk. The Screening for Heart Attack Prevention and Education, or SHAPE, task force says that earlier detection could prevent hundreds of thousands of heart attacks and strokes every year.
Every year, more than 800,000 people die from cardiovascular diseases. This compares with 500,000 deaths annually from all cancers combined. Testing to detect cancer before symptoms occur is well-established in the United States. But the same cannot be said for cardiovascular screening.
Doctors currently screen people by asking about risks for heart disease. The questions usually pertain to high blood pressure and cholesterol, family history, obesity, diabetes, inactivity, stress and smoking.
Most of the population can lay claim to one or more of these factors. But risk factors that are so common in the population are not effective in identifying individuals with heart disease.
Better screening method
Here’s where the SHAPE program comes in. The task force says that most men ages 45 to 75, and most women ages 55 to 75, should receive screening tests. Excluded from screening are people at very low risk and those with symptoms or a diagnosis of heart disease.
Screening would consist of noninvasive tests. The task force suggests a carotid ultrasound, which uses sound waves to look for plaque clogging up and thickening the walls of arteries in the neck.
A computer tomography scan – to look for plaque calcifications within the arteries of the heart, called the coronary artery calcification score – is the other test currently recommended by the task force.
Evidence about what constitutes the best screening tests may change as technology improves.
Based on the test results, people can then be classified according to risk. Those deemed at lower risk for heart disease are advised to monitor cholesterol levels and return for testing in 5 to 10 years.
People found to have moderate or high risk are given more stringent cholesterol guidelines and are followed more closely. Lifestyle changes that are recommended depend on each individual’s level of risk.
The guidelines treat all people over age 75 as high-risk without testing. In most cases, this would mean receiving cholesterol-lowering medications.
The task force found that the SHAPE approach is a cost-effective way to screen for cardiovascular disease before symptoms occur. If all of the estimated 50 million Americans meeting the criteria were screened, about 500,000 heart attacks and thousands of strokes could potentially be averted each year.
I think this approach is well worth considering, since it may help head off the leading cause of death in both men and women. Ask your doctor how the SHAPE guidelines may apply to you.
For more information: See the SHAPE report in the July 17, 2006, supplement to American Journal of Cardiology.
Contact Dr. Elizabeth Smoots, a board-certified family physician and fellow of the American Academy of Family Physicians, at doctor@practicalprevention.com. Her columns are not intended as a substitute for medical advice or treatment. Before adhering to any recommendations in this column consult your health care provider.
2007 Elizabeth S. Smoots.
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