Who should undergo electrocardiogram (EKG) and stress test screening for cardiovascular disease (CVD)?

From the Guidelines

Individuals Who Should Undergo EKG and Stress Test Screening

Individuals with a history of hypertension, hyperlipidemia, or diabetes mellitus, as well as those with a family history of cardiovascular disease, should undergo screening for cardiovascular disease with an electrocardiogram (EKG) and stress test 1.

Key Factors for Screening Consideration

• Age: Asymptomatic individuals aged 40-75 years with a 10-year atherosclerotic cardiovascular disease (ASCVD) risk score of 5% or higher, as calculated using the Pooled Cohort Equations, should also be considered for screening 1.
• Risk Factors: A history of smoking, dyslipidemia, or abnormal electrocardiogram (ECG) findings, such as left ventricular hypertrophy, left bundle branch block, or ST-T abnormalities, are also indications for screening 1.
• Medications: Patients taking medications such as beta blockers, nitrates, or anti-arrhythmic agents, including metoprolol (50-200mg daily) or atenolol (25-100mg daily), may require adjusted stress test protocols to ensure accurate results.

Additional Considerations

• Exercise ECG testing without or with echocardiography may be used as the initial test, while pharmacologic stress echocardiography or nuclear imaging should be considered in individuals with diabetes in whom resting ECG abnormalities preclude exercise stress testing 1.
• Coronary artery calcium measurement is also reasonable for cardiovascular risk assessment in adults with diabetes ≥40 years of age 1.

Important Notes

• The decision to screen should be based on the individual's overall risk profile and the potential benefits and harms of screening 1.
• The USPSTF recommends against routine screening with EKG or stress testing in asymptomatic adults at low risk for cardiovascular disease 1.

From the Research

Eligibility for Electrocardiogram (EKG) and Stress Test Screening

The following individuals should undergo electrocardiogram (EKG) and stress test screening for cardiovascular disease (CVD):

• Those with a family history of cardiovascular disease, as it increases the risk of CVD 2, 3, 4, 5
• Hypertensive individuals, especially those with a positive family history of CVD, as they are at higher risk of nonstroke cardiovascular disease and stroke 2
• Individuals with a history of myocardial infarction, as family history of early-onset atherosclerotic cardiovascular disease is associated with recurrent ASCVD 3
• Those with diabetes mellitus, particularly with comorbid risk factors such as hypertension, hyperlipidemia, smoking, obesity, and sedentary lifestyle, as they are at increased risk of peripheral vascular disease 6
• Individuals with non-alcoholic fatty liver disease (NAFLD), especially those with a family history of CVD, diabetes, dyslipidemia, and hypertension, as they are at higher risk of laboratorial abnormalities and syndromes 5

Key Factors to Consider

When determining eligibility for EKG and stress test screening, the following factors should be considered:

• Family history of CVD, including the presence of CVD in first-degree relatives such as parents, grandparents, and siblings 2, 3, 4, 5
• Presence of comorbid risk factors, such as hypertension, hyperlipidemia, smoking, obesity, and sedentary lifestyle 6
• History of myocardial infarction or other cardiovascular events 3
• Presence of diabetes mellitus or other metabolic disorders 4, 5, 6
• Age, sex, and ethnicity, as these factors can influence the risk of CVD 2, 3, 4, 5, 6