Disease of the cardiovascular system — the heart and blood vessels — is the leading cause of death for both women and men in the United States. In coronary artery disease (CAD), fatty deposits in the cells of the artery walls narrow the diameter of the blood vessel and reduce blood flow (called atherosclerosis). This insufficient blood flow can lead to abnormal heart rhythms, angina, heart failure (a decreased ability of the heart to keep up with its workload), myocardial infarction or “heart attack,” and sudden cardiac death.
Coronary Artery Disease Risk Factors
If you are a man under age 40 or a woman who has not yet gone through menopause, you probably do not have CAD to any great extent. However, the likelihood increases as you age. The risk also is higher if you smoke; have high blood pressure, diabetes, or high cholesterol levels; lead a sedentary lifestyle; eat an unhealthy diet; or have a family history of heart disease.
Coronary Artery Disease Screening Tests
It seems reasonable to believe that the early detection of CAD — that is, before any symptoms appear — would be beneficial.
The most common way is to analyze the electrical impulses of the heart during rest and exercise. In this quick and painless procedure, electrodes placed on your skin gather information that becomes a recording (the electrocardiogram, or ECG). The ECG shows the workings of the heart—the triggering of heartbeats, the conduction of nerve impulses, and the rate and rhythm of the heart.
Another way to test heart function under active conditions is an exercise ECG, often called a “treadmill test.” In this test you exercise by walking on a treadmill at increasing speed while your heart is monitored. Changes in the ECG such as irregular heart beats can be monitored during the activity.
Unfortunately, the ECG is not a good screening test because of the high number of “false negatives” — people with heart disease who have no changes in their heart when resting. The exercise testing is better, but far more expensive and still not able to find heart disease which is not already fairly severe — again a high number of “false negatives.” Therefore, neither test can be recommended for screening the general population, especially those with no or few clear risk factors.
For those with high personal or family risks of heart disease, a discussion with your primary health care practitioner about when and if ECG testing might benefit you is appropriate, after age 40 in men and after menopause, or about age 50, in women.