From the Guidelines
Cardiovascular screening is recommended for adults aged 40 to 75 years without a history of cardiovascular disease, as well as those with risk factors such as hypertension, diabetes, high cholesterol, obesity, or tobacco use, and those experiencing symptoms like chest pain, shortness of breath, or palpitations. When considering who should undergo cardiovascular screening, several factors come into play, including age, family history, and the presence of other risk factors. According to the US Preventive Services Task Force recommendation statement published in JAMA in 2016 1, the focus has shifted from screening for dyslipidemia to assessing overall cardiovascular risk to identify adults who may benefit from statin therapy. This approach emphasizes the importance of evaluating individuals aged 40 to 75 years without a history of cardiovascular disease for statin use to reduce their risk of experiencing a cardiovascular event. Key factors that may prompt cardiovascular screening include:
- Age: Adults aged 40 to 75 years
- Family history of cardiovascular conditions
- Presence of risk factors such as hypertension, diabetes, high cholesterol, obesity, or tobacco use
- Symptoms like chest pain, shortness of breath, or palpitations
- Occupations requiring cardiovascular fitness, such as pilots or firefighters The European guidelines on cardiovascular disease prevention in clinical practice, published in the European Heart Journal in 2012 1, also recommend risk factor screening, including lipid profile, in adult men ≥40 years old and in women ≥50 years of age or post-menopausal. The screening process typically involves:
- Blood pressure measurement
- Cholesterol testing
- Blood glucose assessment
- Electrocardiograms (ECGs) or stress tests, depending on risk level Regular screening intervals vary based on individual risk factors, ranging from annually for high-risk individuals to every 3-5 years for those at lower risk. Early detection through screening can identify cardiovascular issues before they become serious, allowing for timely intervention with lifestyle modifications or medications.
From the Research
Eligibility for Cardiovascular Screening
The following individuals should undergo cardiovascular screening:
- Adults aged 40 to 79 years, as recommended by the American College of Cardiology/American Heart Association (ACC/AHA) to estimate risk using the atherosclerotic cardiovascular disease (ASCVD) pooled cohort equations 2
- Older adults, especially those older than 75 years, as they are at a higher risk of cardiovascular disease (CVD) and have been underrepresented in clinical investigations 3
- Individuals with a family history of CVD, as they are at a higher risk of developing CVD themselves 4
- Patients with rheumatoid arthritis (RA), as they have a markedly increased mortality risk due to CVD despite lower lipoprotein levels in comparison with the common population 5
- Individuals with underlying risk factors, such as hyperlipidaemia, hypertension, diabetes, obesity, smoking, and lack of physical activity, which collectively represent more than 90% of the CVD risks in all epidemiological studies 6
Risk Assessment and Prevention
Cardiovascular screening should include:
- Estimation of 10-year ASCVD risk using the ASCVD pooled cohort equations 2
- Assessment of risk factors, such as lipid profile, blood pressure, blood glucose, and cholesterol levels 6, 2
- Counseling on healthy lifestyle modifications, such as no tobacco use, ideal blood pressure, blood glucose, and cholesterol levels, adequate physical activity, weight management, and healthy diet 2
- Consideration of CVD risk enhancers, such as coronary artery calcium assessed by computed tomography, to inform clinician-patient discussions 2