Heart screening tests
Posted by medconsumers on February 21, 2011
Consumer Reports is to be congratulated on its ratings for heart screening tests. In much the same way this popular magazine has always presented test results for toasters, cars, and sneakers, CR has assessed the research supporting nine heart screening tests. Only two—blood pressure measurement and the standard blood test—have strong evidence indicating that the benefits clearly outweigh the risks.
The evidence for the other seven tests, on the other hand, was judged to be either minimal or nonexistent. These include electrocardiogram (EKG), a blood test for C-reactive protein (CRP), exercise stress test (EKG), electrocardiogram (ECG), and ultrasound tests for clogged carotid arteries (neck), peripheral artery disease (leg), and abdominal aortic aneurysm (AAA). Yet these heart tests are frequently advised for healthy people without heart disease, high blood pressure or high cholesterol.
CR surveyed 8,056 subscribers (male and female, ages 40 to 60 years) and learned that 44% had had at least one of the seven unnecessary heart tests in the last five years. These tests are more than just a waste of time and money; they present a small chance of harm and absolutely no proven benefit.
In the introduction to the rating section, CR sets just the right tone, “When it comes to screening tests for heart disease, more is not always better. Some people get tests they don’t need while failing to get those they do.” After you type in your age, gender, and risk level, up comes CR’s familiar format that helps you identify the tests most likely to be helpful to you personally. Five rating levels range from “benefits very likely to outweigh the risks” to “benefits are very unlikely to outweigh the risks.” For this rating system, CR drew entirely from the work of the highly respected U.S. Preventive Services Task Force.
It was surprising to see that such a large portion of the CR survey respondents were uninformed about the downside of testing. (Surprising, given that CR readers would be expected to be high-level information seekers.) The most serious harms are not from the test itself but from what doctors call the “cascade effect”—that is, the biopsies, major surgery, long-term drug therapy, etc. that can result from false alarms. Only 11% of the people in the CR survey said that they had had a conversation with their doctor about what the follow-up would be should their screening test find an abnormality.
For more information
-Go to CR’s information about heart tests, available free at “Ratings for screening tests for heart disease.”
-If you’re over the age of 45, you have probably received a letter from Life Line, a for-profit company that promotes the three most useless heart tests directly to the public. The letter will tell you when and where one of its mobile screening units will be setting up shop in your neighborhood. Consumer beware click here.
-The CR rating for cholesterol testing (a component of a blood test) is overly optimistic read this. For many people, the cascade effect of cholesterol testing is a lifetime of statin drugs. Two-thirds of all Americans taking statins do not have heart disease. read “Statins don’t work for people without heart disease” and “Going on statins? take a close look at the size of the benefit”.
-CR did not rate heart scans, which involve a large dose of radiation. These scans should not be used for screening purposes, but indeed they are. read this
Maryann Napoli, Center for Medical Consumers©