A possible new approach to cardiovascular screening

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Who exactly should be screened for cardiovascular disease? New research indicates that a computerized tomography (CT) scan of the coronary arteries can uncover risks of heart disease even in patients without clinical symptoms or even risk factors.

In a study published in the Journal of the American College of Cardiology, Yale University s Dr. Khurram Nasir and colleagues used a coronary artery CT scan to detect coronary calcium buildup in over 3,700 patients none of whom had elevated LDL-cholesterol (bad cholesterol) levels. Surprisingly, calcium buildup, as determined by their calcium score, was strongly associated with an increased risk of heart attack or stroke, even in this group of asymptomatic patients with low to normal LDL cholesterol.

The researchers suggest that such screenings may be used as a basis for deciding which patients with low LDL cholesterol may be considered for more aggressive therapies. However, ACSH' s Dr. Gilbert Ross is puzzled as to how it will be determined just which asymptomatic patients merit this CT scan. According to this study, he notes, it seems like everybody should be screened, or at least men over age 40 and women at age 50. ACSH s Dr. Josh Bloom wonders if this could end up being analogous to a mammogram if it is as successful at detecting incipient heart disease as it seems. But neither Dr. Ross nor Dr. Bloom considers such a measure a practical recommendation at this point, and agree that the initial study needs to be replicated and expanded.