By William L. Driscoll
Five cardiologists have proposed that doctors test people for clogged arteries, and offer those found to have the disease a statin prescription, to prevent heart attacks and strokes.
Their proposal, which would overhaul current medical practice, was published as a state-of-the-art review by the Journal of the American College of Cardiology.
Current medical practice to prevent heart attacks and strokes among those without symptoms is based on a risk-scoring system to predict those most likely to have a heart attack or stroke.
The cardiologists propose instead to “treat the disease rather than the likelihood of disease,” by directly testing for clogged arteries.
Artery clogging that has not yet caused symptoms can be detected using any of four “readily available” imaging tests, they say.
One of those tests, a carotid artery ultrasound, is available in the U.S. without a doctor’s order, from Life Line Screening. The test is like the ultrasound test for pregnant women, except that it scans the neck instead of the belly.
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The other tests require a doctor’s order. One is an ultrasound scan of the infrarenal
aorta, a major artery below the kidneys. The others are two versions of a
coronary artery calcium test, which assesses the level of calcium in the coronary
arteries that serve the heart muscle, using a type of X-ray called computed
tomography. One version of that test uses a contrast agent and the other does
The other three tests require a doctor’s order. One is an ultrasound scan of the infrarenal aorta, a major artery below the kidneys. The others are two versions of a coronary artery calcium test, which assesses the level of calcium in the coronary arteries that serve the heart muscle, using a type of X-ray called computed tomography. One version of that test uses a contrast agent and the other does not.
The cardiologists present a carefully reasoned case for their proposal. First, they say the majority of heart attacks occur due to the rupture of plaque on an artery wall, where the plaque was partially clogging the artery. They add that plaque progression is “a necessary and modifiable step” between early-stage artery clogging and a heart attack. For patients for whom screening finds early-stage artery clogging, “intensive” lipid-lowering therapy would begin “to halt plaque progression” to prevent a heart attack.
The cardiologists did not suggest how to determine which patients are appropriate for noninvasive screening that checks for artery clogging. As noted above, individuals who have reached middle age can get themselves checked for artery clogging, without a doctor’s order.
The article—which uses the medical term “atherosclerosis” to refer to artery clogging—is titled “From Subclinical Atherosclerosis to Plaque Progression and Acute Coronary Events: JACC State-of-the-Art Review.” It is available free online.