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by Rudis J

Screening for Coronary Artery Disease (CAD)

The purpose of screening is to find a disease in early stages. Some tests are given to people that do not yet have symptoms. Other tests may only be given to those at high risk. Early diagnosis of CAD may slow or prevent future damage to the heart.

Screening Guidelines and Tests

CAD screening is often done as part of regular exams. The following are regular screening tests that help to identify risk factors for developing CAD:
Blood Tests
Blood tests can identify factors that can lead to CAD. These include:
  • High cholesterol
    • Your total cholesterol should be checked every 5 years once you reach the age of 20
    • More frequent testing may be recommended if you have had:
      • High LDL cholesterol or triglycerides
      • Low HDL cholesterol
      • Other factors that increase your risk of heart disease
  • Blood glucose
    • Screens for diabetes or pre-diabetes
    • Should be checked every 3 years after age 45 years
Body Weight
Your body weight should be checked at each exam once you reach the age of 20. Your doctor will assess:
  • Body mass index (BMI)
  • Waist circumference
Excess weight is a risk factor for CAD.

Screening Tests for High Risk Populations

If you are at high risk of developing CAD, you doctor may recommend screening tests such as:
Blood Tests
Elevated C-reactive is a protein marker found in the blood. This marker appears when there is an inflammatory response in the body. An increased level is linked with a higher risk for CAD.
ECG
An ECG records the electrical activity of your heart. It is done with electrodes that are placed on the skin. An ECG may be able to show changes in your heart's rhythm. It can also show if the heart has been damaged. However, a normal ECG does not mean you are free of CAD. Most early changes are not seen on this test.
Chest X-ray
Your doctor may order chest x-rays . It will show your heart's size. Your doctor will also be able to see any signs of congestion in the lungs.
Cardiac CT Scan
This CT scan is also known as coronary artery calcium scoring. It is an advanced x-ray that can show calcium levels in the arteries of the heart. The results are shown 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. It is also a marker for increased risk of artery disease in the heart. 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 a blockage between your heart and your leg. Atherosclerosis is a systemic disease. If it is present in one area of the body it is likely present in other areas.
Carotid Intima-media Thickness (IMT)
Measuring the thickness of the two innermost layers of the arterial wall. It may detect the presence of atherosclerosis. However, research has not determined if the relationship to CAD is clinically significant enough. It is not clear whether IMT is a good screening tool for CAD.

References

Balbarini A, Buttitta F, Limbruno U, 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(4):269-279.
C-reactive protein (CRP) and other biomarkers as cardiac risk factors. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116446/C-reactive-protein-CRP-and-other-biomarkers-as-cardiac-risk-factors . Updated February 25, 2016. Accessed March 5, 2018.
Coronary artery disease (CAD). EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116156/Coronary-artery-disease-CAD . Updated February 28, 2018. Accessed March 5, 2018.
Cardiac CT for calcium scoring. Radiology Info—Radiological Society of North American website. Available at:https://www.radiologyinfo.org/en/info.cfm?pg=ct%5Fcalscoring. Updated January 20, 2018. Accessed March 5, 2018.
Heart-health screenings. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/More/ConsumerHealthCare/Heart-Health-Screenings%5FUCM%5F428687%5FArticle.jsp#.Wp2AzmrwbIU. Updated June 1, 2017. Accessed March 5, 2018.
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(4):632-637.

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