From the Guidelines
The next recommended screening for this 67-year-old male with a family history of stroke and well-controlled hyperlipidemia on rosuvastatin is not carotid ultrasound, as the US Preventive Services Task Force recommends against screening for asymptomatic carotid artery stenosis in the general adult population, regardless of risk factors. According to the US Preventive Services Task Force recommendation statement 1, the harms of screening for asymptomatic carotid artery stenosis outweigh the benefits. The major risk factors for carotid artery stenosis, including older age, male sex, hypertension, smoking, hypercholesterolemia, diabetes mellitus, and heart disease, do not justify screening in asymptomatic individuals.
Instead, the patient should focus on regular monitoring and management of his existing risk factors, such as:
- Regular blood pressure monitoring
- Annual lipid panels to ensure continued control on rosuvastatin
- Hemoglobin A1C testing to screen for diabetes
- A comprehensive cardiovascular risk assessment, including an electrocardiogram, may also be appropriate
Additionally, considering the patient's age and smoking history is unknown, the US Preventive Services Task Force recommends one-time screening for abdominal aortic aneurysm (AAA) by ultrasonography in men ages 65 to 75 years who have ever smoked 1. If the patient has a history of smoking, this screening should be considered. However, if he has never smoked, the decision to screen for AAA should be made on an individual basis, taking into account his medical history, family history, and personal values.
From the Research
Patient Profile
- 67-year-old male
- No history of CVA, TA, or neurologic symptoms
- Family history of stroke (father died from an embolic stroke at 71)
- Normal vital signs
- BMI of 27
- Well-controlled hyperlipidemia on rosuvastatin
Recommended Screening
Based on the US Preventive Services Task Force (USPSTF) guidelines, the recommended next screening for this patient is:
- One-time screening for abdominal aortic aneurysm (AAA) with ultrasonography, as the patient is a male aged 65-75 years with a family history of AAA 2, 3
- However, since the patient has never smoked, the USPSTF recommends that clinicians selectively offer screening for AAA with ultrasonography, rather than routinely screening all men in this group 2
Key Considerations
- The patient's family history of stroke and well-controlled hyperlipidemia do not directly influence the recommendation for AAA screening 4, 5
- The USPSTF guidelines do not recommend routine screening for asymptomatic carotid stenosis, but selective screening may be considered for high-risk individuals 4
- Ultrasound screening for AAA in primary care has been shown to be useful in detecting AAA and subclinical atherosclerosis, and reclassifying vascular risk 6