When it comes to heart disease, people seem to think the more screening tests the better—even those that generally aren't recommended by medical experts. That's one implication of a recent survey of 8,056 Consumer Reports' subscribers, which also revealed uncertainty about assessing one's risk of cardiovascular disease and the most effective strategies for preventing it.
To help clear up the confusion, we have for the first time rated heart-disease screening tests, identifying those you should consider and those you can probably skip. We've also developed a calculator that estimates your chance of having a heart attack, stroke, or other cardiovascular event in the next 10 years, and that recommends the preventive measures—including lifestyle changes and, in some cases, medication—that make most sense for you.
The survey respondents were asked whether they had received any of 10 heart-specific screening tests in the last five years. Nearly two-thirds of them—all of whom were between 40 and 60, had seen a doctor in the last 12 months, and had no history or symptoms of any form of cardiovascular disease—said they would definitely have a complete battery of heart-screening tests if they were free.
In fact, many of our respondents had already had at least one test generally recommended only for people with symptoms of cardiovascular disease or at very high risk of it. Fifty percent said they had undergone an electrocardiogram (EKG), 21 percent an exercise stress test, and 7 percent an ultrasound of the carotid arteries.
Most of them did so without first getting crucial information from a doctor or doing their own research on the accuracy of the tests, the potential complications, or what they would need to do if the tests came back with worrisome results. And almost everyone seemed to think that no harm could come from overtesting: 87 percent completely or somewhat agreed that it was “better to have a scare that turns out to be nothing than to not get tested at all.”
But in fact those scares can lead to real harm. “Yes, all adults should regularly get their blood pressure measured, and many should also get screened for high cholesterol levels and type 2 diabetes,” says John Santa, M.D., M.P.H, director of the Consumer Reports Health Ratings Center. “But other tests often have the potential to do more harm than good when used in people who don’t have signs or symptoms of heart disease.”
That’s because tests tend to be less accurate for low- or normal-risk people and can trigger a cascade of unnecessary, costly, and in some cases potentially risky follow-up tests. For example, 12 percent of the respondents who not only had no history of heart disease but also normal blood pressure and cholesterol levels said they had undergone an exercise stress test. But abnormal results from that test, which are common in healthy people, often lead to additional tests, including CT angiography. That test, which combines dye injection with an ultrafast scanner to make a three-dimensional image of the heart, can expose you to 200 times as much radiation as a standard chest X-ray and, according to some research, increase the risk of developing cancer.
Perhaps most worrisome, unnecessary testing often leads to unnecessary treatment. “Once a doctor sees something on a test that is even remotely abnormal,” Santa says, “it’s hard to resist the urge to do something—prescribe drugs, sometimes even refer people to an invasive procedure like angioplasty—even when there’s no evidence that it helps.”
See our Ratings of heart-screening tests to see which are right for you.
Know your risk
Our survey also found confusion among respondents about their risk for a heart attack or stroke. For example, 29 percent of the people with no history of heart disease and normal blood pressure and cholesterol levels described themselves as being at high risk of heart disease, though only 9 percent said they had actually heard that from a doctor.
Having an accurate assessment of your risk for heart attack is key for several reasons.
First, it can help determine which screening tests are right for you. For example, 42 percent of the respondents said they had their blood tested for C-reactive protein, a marker of possible inflammation of the coronary arteries and a relatively new risk factor for heart disease. Such testing can indeed be a good idea for people at intermediate risk of heart disease, but it’s generally inappropriate for those at low or high risk.
Second, an accurate risk assessment can help determine when treatment is and isn’t necessary. While aspirin can reduce the risk of heart attacks and strokes, for example, it also poses a risk of gastrointestinal bleeding. To know whether the benefits outweigh the risks for you, you need to know your chance of having one of those events in the next 10 years. Similarly, people with an LDL (bad) cholesterol level of 130 milligrams per deciliter might need to take medication to lower their cholesterol level if they’re at high risk of heart disease, but only need to make lifestyle changes if they’re at low or moderate risk.
Use our calculator to estimate your chance of having a heart attack or stroke in the next 10 years.
How to protect your heart
Finally, people in our survey seemed uncertain about the steps they should focus on to protect their heart.
While nearly everyone (84 percent) said that stopping smoking was extremely important, only 58 percent said the same about regular exercise, 43 percent about avoiding food high in saturated fat or cholesterol, 39 percent about managing stress, 30 percent about avoiding sodium, and 9 percent about taking low-dose aspirin.
Part of that uncertainty might stem from poor communication with their doctors. One in four people with normal blood pressure and cholesterol levels said they had not discussed heart-protective behaviors with a physician in the past five years. That’s unfortunate, since respondents who had such conversations were much more likely to have taken steps to eat right, exercise more, and ease stress.
Our recommendations for you on those and other issues, based on the profile from our calculator can help as you do your own research and talk with a doctor about the screening tests you need and the preventive measures you should take.
—Joel Keehn, senior editor