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CVD screening in low-risk, asymptomatic adults: clinical trials needed

Nature Reviews Cardiology volume 9, pages 599–604 (2012)Cite this article

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Abstract

The public-health impact of cardiovascular disease (CVD) remains high despite advances in prevention and treatment. Large numbers of cardiovascular events occur in asymptomatic people who do not have a high level of risk from single risk factors or in terms of multivariable risk scores. Novel risk markers, such as carotid intima–media thickness, high-sensitivity measurement of C-reactive protein, coronary artery calcium score, and genetic risk scores have been suggested as new ways to identify candidates for primary prevention of CVD through intensive risk-factor modification. Yet, many questions remain unanswered. Can these novel markers be used to identify adults who will benefit from statin therapy? How will novel markers affect medication adherence? Is screening using these markers cost-effective? Our opinion is that clinical trials of one or more of these novel tests, combined with monitoring of traditional risk factors, are needed in asymptomatic, low-risk populations.

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Figure 1: The observed number of deaths at each level of predicted risk in men aged 50–59 years in the SCORE dataset.
Figure 2: Calculation of the NRI.

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Author information

Authors and Affiliations

  1. Department of Medicine, University of Chicago Medical Center, Section of Cardiology, 5841 South Maryland Avenue, MC 6080, Chicago, 60637, IL, USA

    Tamar S. Polonsky

  2. Departments of Preventive Medicine and Medicine, Northwestern University, Feinberg School of Medicine, 680 North Lake Shore Drive, 14th Floor, Chicago, 60611, IL, USA

    Philip Greenland

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Both authors researched data for the article, contributed to the discussion of content, and wrote the manuscript.

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Correspondence to Philip Greenland.

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The authors declare no competing financial interests.

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Polonsky, T., Greenland, P. CVD screening in low-risk, asymptomatic adults: clinical trials needed. Nat Rev Cardiol 9, 599–604 (2012). https://doi.org/10.1038/nrcardio.2012.114

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