Heart Attack Tests For Everyone?

Group Of Cardiologists Calls For Change In Testing For Heart Risk

(WebMD)  Naghavi bristles at the argument that the screening tests aren't ready for prime time.

Tests Uncover Major Risks

"To those who say the technology isn't there yet, we say check with recent discoveries," Naghavi says.

"For the very first time in heart medicine, we now have a test that can show someone has up to a 65-fold increased risk of a heart attack,” he says. “With the traditional risk factors, the biggest risk is high cholesterol, which has only up to 4.5-fold increased risk. So you can see how much of a jump in prediction we get from this.”

But Bild says there are simply too many unanswered questions about the new screening tools.

"We always advise caution before launching a widespread screening program," she says. "We would emphasize the need for a clear look at the tests' cost effectiveness, the accuracy of the tests, the availability of the tests, and most important, what interventions should be done based on the tests. We would also be concerned about telling people they have a disease that puts them at risk without clear evidence that treatment will change their outcomes."

The Risks

Topol notes that screening has risks — and that the tests' unproven benefit does not outweigh those risks.

"These tests just show you have a lot of cholesterol in your artery, or an artery that is narrowing," he says. "We don't know how good they are in predicting heart attacks. So you could get a test that shows a narrowing of your artery, and end up with a drug-coated stent in your artery for no reason.”

Shah says the real risk is that people will continue to die of heart attacks their doctors never saw coming.

"If we wait for definitive clinical trials, we will keep losing individuals to heart attacks because they have never been screened," he says. "This is a challenge to the medical community. It does not preclude clinical trials. But in the meantime, you have to do medicine based on collective wisdom and collective knowledge.

“The bulk of evidence supports this initiative," says Shah.

How Much Would You Pay?

The new screening tests aren't cheap. Shah estimates that a CT heart scan ranges from $100 to $350, while an ultrasound arterial scan ranges from $300 to $400. Since the tests aren’t officially recommended, most insurance and health maintenance plans won't pay for them.

Multiply the costs by nearly every middle-aged American adult and you have a big up-front expense — even if the SHAPE doctors persuade insurance companies the tests will save them money in the long run.

WebMD asked Shah what he says to patients who balk at the price tag. His response: "You spend $400 or $500 on car maintenance. Isn't your body worth as much?

"As the evidence behind the tests builds and they become more mainstream, the costs are going to come down,” Shah adds. "Meanwhile, it is still much more expensive to have a heart attack than CT scan."

SOURCES:: Naghavi, M., American Journal of Cardiology, July 10, 2006 (manuscript received in advance of publication). Morteza Naghavi, M.D., founder and president, Association for Eradication of Heart Attack (AEHA). Prediman K. Shah, M.D., head of cardiology, Cedars-Sinai Medical Center; professor of medicine, UCLA. Eric J. Topol, M.D., chairman of cardiology, Case Western Reserve University, Cleveland. Diane Bild, M.D., deputy director, division of epidemiology and clinical applications, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md.