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Screening for Coronary Artery Disease (CAD)

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The purpose of screening is early diagnosis and treatment. Screening tests are usually administered to people without current symptoms, but who may be at high risk for certain diseases or conditions.

There are no screening tests for CAD itself. Instead, most screening is aimed at prevention of CAD and identifying the risk factors associated with the development of CAD.

Screening Guidelines

The following are regular screening tests that help to identify risk factors for developing CAD. These tests are often done as part of regular physical exams.

Blood Tests

Blood test can help look for conditions that can lead to CAD. These include:

  • Cholesterol—Your total cholesterol should be checked every five years once you reach the age of 20. Your doctor may recommend more frequent testing if you have high LDL cholesterol or triglycerides, low HDL cholesterol, or other factors that increase your risk of heart disease.
  • Blood glucose—Once you reach the age of 45, your blood glucose should be checked every three years. Blood glucose testing screens for diabetes.
Body Weight

Your body weight should be checked at each exam once you reach the age of 20. Your doctor will assess your body mass index (BMI) and waist circumference to determine if you are at a healthy weight. Excess weight increases blood pressure, cholesterol, and blood glucose levels. All of these compound your risk of CAD.

Screening Tests for High Risk Populations

If you are at high risk of developing CAD, you doctor may recommend screening tests to look for signs of CAD. These include:

Blood Tests

Elevated C-reactive protein levels may indicate an inflammatory response in the body. This elevation is associated with a higher risk for CAD.

Electrocardiogram (EKG)

If your doctor suspects that you are at risk of developing CAD, you may have an EKG. This test records the electrical activity of your heart through electrodes attached to the skin. An EKG may be able to show changes in your heart's rhythm or damage to heart muscle. However, a normal EKG does not mean you are free of CAD, since most early changes are not seen on this test.

Chest X-ray

Your doctor may order chest x-rays to check your heart's size your lungs for signs of congestion.

Cardiac CT Scan

Also known as coronary artery calcium scoring, this noninvasive x-ray examination detects calcium levels in the coronary arteries, expressing the findings as a calcium score. Calcium build-up is a marker of CAD.

Ankle-brachial Indices

Peripheral arterial disease (PAD), the hardening of the arteries outside of the heart, is also a marker for increased cardiac risk. An ankle-brachial index measurement is done to screen for and diagnose PAD. Blood pressure is measured at your ankle and at your arm. If blood pressure is lower in your ankle, it indicates that an artery between your heart and your leg may be blocked. Atherosclerosis is a systemic disease, and its presence in one area of the body increases your risk for disease in other areas as well.

Carotid Intima-media Thickness (IMT)

Measuring the thickness of the two innermost layers of the arterial wall may detect the presence of atherosclerosis. However, research has not determined if the relationship to CAD is clinically significant enough to recommend measurement of IMT as a screening tool.

Revision Information

  • Balbarini A, Buttitta F, et al. Usefulness of carotid intima-media thickness measurement and peripheral B-mode ultrasound scan in the clinical screening of patients with coronary artery disease. Angiology. 2000;51:269-279.

  • C-reactive protein (CRP) as a cardiac risk factor. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 9, 2012. Accessed January 29, 2014.

  • Coronary artery disease (CAD). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 16, 2013. Accessed January 29, 2014.

  • Cardiac CT for calcium scoring. Radiological Society of North American Radiology Info website. Available at: http://www.radiologyinfo.org/en/info.cfm?pg=ct%5Fcalscoring. Updated April 19, 2013. Accessed January 29, 2014.

  • Heart-health screenings. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/More/ConsumerHealthCare/Heart-Health-Screenings%5FUCM%5F428687%5FArticle.jsp. Updated October 15, 2013. Accessed January 29, 2014.

  • Zebrack JS, Muhlestein JB, Horne BD, Anderson JL. Intermountain Heart Collaboration Study Group. C-reactive protein and angiographic coronary artery disease: independent and additive predictors of risk in subjects with angina. J Am Coll Cardiol. 2002;39:632-637.