Heart Attack Tests for All?
Group of Prominent Cardiologists Calls for Radical Change in Testing for Heart Risk
No Change in Official Guidelines
The SHAPE recommendations won't change official U.S. guidelines, says Diane
Bild, MD, deputy director of the division of epidemiology and clinical
applications at the National Heart, Lung, and Blood Institute of the National
Institutes of Health, Bethesda, Md.
"What we really need for [federal] guideline recommendations is just not
available yet," Bild tells WebMD. "This is a laudable effort to move
preventive cardiology forward. But it occurs with a lack of the complete and
clear information that we need to make guidelines.
"The tests are out there. They are being used," Bild says. "It
is just not clear what the value of these tests really is -- and whether
treatment should be targeted based on those tests."
Naghavi bristles at the argument that the screening tests aren't ready for
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
But Bild says there are simply too many unanswered questions about the new
"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
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
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.