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Last Updated: 11/26/2013  

Screening for Coronary Artery Disease

  • Be aware that CAD is the leading cause of mortality in U.S. adults.

  • Recognize that initial effective strategies for the primary prevention of CAD begin with the assessment of an individual's risk factor profile and treatment of modifiable risk factors such as hypertension, hyperlipidemia, diabetes, and tobacco use.

  • Do not perform cardiovascular screening tests to assess risk in asymptomatic patients identified as low risk (less than 10% chance of CAD in 10 years).

  • Recognize that certain cardiovascular screening tests may be used for patients identified as intermediate risk (10% to 20% chance of CAD in 10 years) to diagnose occult CAD or to provide additional information about the risk for future cardiovascular events.

  • Exercise electrocardiography, CAC scoring, carotid artery IMT measurement, CRP, hemoglobin A1C, urinalysis for microalbumin, lipoprotein-associated phospholipase A2, or ankle-brachial index may be considered for cardiovascular risk assessment in asymptomatic adults with an intermediate global risk for CAD (10% to 20% risk for a cardiovascular event over 10 years).

  • Be aware that there is no role for further cardiovascular screening tests for patients identified as high risk (more than 20% chance of CAD in 10 years) as these individuals are already candidates for intensive preventative interventions, and added testing is unlikely to change treatment.

  • Note that resting electrocardiography may provide risk information but is generally not recommended for screening.

  • Recognize that it is unclear whether making treatment decisions on the basis of added prognostic information provided by screening tests for asymptomatic CAD is cost-effective or leads to reduced CAD events.

DOI: 10.7326/s376
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Disclosures:
Angela Fowler-Brown, MD, MPH has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Michael Pignone, MD, MPH received honorarium from Pfizer, received grants from Pfizer. Matthew Budoff, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
The following editors of ACP Smart Medicine have nothing to disclose: Deborah Korenstein, MD, FACP, Editor in Chief; Richard B. Lynn, MD, FACP, Editor; and Davoren Chick, MD, Editor.
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