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Heart Health Screenings: What Do You Need, and When Do You Need It?
By Nancy Kennedy

Dr. Daniel EdmundowiczCardiovascular disease, meaning disease related to the heart and blood vessels, is the leading cause of death and disability among adult Americans. It kills more people every year than all other causes of death combined. On an average day 3,000 Americans will die of cardiovascular disease. The most common type of heart disease, coronary artery disease, is the result of blockages in the arteries that supply blood to the heart itself; the blockages form when cholesterol deposits begin to line the artery walls, gradually narrowing the space through which blood can flow. A myocardial infarction or "heart attack" occurs when oxygen-carrying blood cannot reach the heart muscle, and the deprived tissue becomes damaged or even dies. Cardiovascular disease causes untold suffering, costs the nation billions, affects nearly every family and may result in significant, permanent and sometimes life-altering disability.

Heart disease, however, is almost entirely preventable. Prevention requires a multifaceted approach and one of the most effective strategies is the utilization of heart screening tests. Screening tests can save lives; they detect disease in the earliest stages, when it is easier to treat and more likely to have a successful outcome. Just as mammograms and colonoscopies are reducing deaths from cancer, heart screenings can have a similar impact on heart disease.

Dr. Daniel Edmundowicz, Director of Preventive Cardiology at UPMC Heart and Vascular Institute and Director of Cardiovascular Medicine at UPMC Passavant, emphasizes the importance of screening tests as a means of identifying people at risk for heart disease. "Certain factors are associated with increased risk for developing heart disease, by which we primarily mean coronary artery disease. Some of these factors cannot be changed, such as family history and genetics. But others can be: smoking, obesity, inactivity, high blood pressure, high cholesterol and diabetes. If we screen for risk factors and identify them in the early stages, we can address them with lifestyle modifications and sometimes medications, before heart disease develops."

Standard heart screenings are familiar to most people and can be performed at a physician's office or a community screening event, such as those that take place in shopping malls or supermarkets. They include the following:

  • Body mass index (BMI), which includes weight and height
  • Blood pressure
  • Blood cholesterol level
  • Blood glucose (sugar) level
  • Assessment of one's activity level

Diagnostic cardiac tests, such as stress tests, echocardiograms and EKGs are not necessarily screening tests because they may not detect coronary artery disease in its earliest stages. They are helpful for diagnosing other cardiac conditions for which there may be a high suspicion such as coronary artery disease in the presence of concerning symptoms, rhythm disorders and congestive heart failure.

Until recently, doctors recommended that screening for heart disease begin at the age of 20 but the surge in childhood obesity has forced a change. Now, cardiologists and pediatricians agree that earlier attention to heart screening is called for, since overweight children are at higher risk. "The earlier we begin screening, the better," says Dr. Edmundowicz. "We can catch the early signs and intervene if appropriate. Screening also lets us know who needs to be monitored from then on."

More sophisticated heart screening becomes useful as people reach early middle age: for men, this generally means age 40, and for women, the mid-40's. That's when Dr. Edmundowicz and his colleagues advise screening for evidence of "subclinical" heart disease - disease that is present but without clinical symptoms. Coronary artery calcium scanning and carotid artery ultrasound are examples of the next level of screening and are non-invasive, low or no radiation imaging studies that do not use dye and or require a prescription. For the latter, there are private companies that provide these screenings in mobile clinics, often set up in trailers that travel from one community to another. At a relatively low cost, they make it possible for anyone to have a screening of their carotid arteries. "These tests detect early evidence of plaque deposits in the aorta and arteries," says Dr. Edmundowicz. "They help identify high-risk people. I encourage people to take advantage of this and take the results to their doctors.

UPMC recently partnered with the Maggie Dixon Foundation to sponsor a Heart Health Fair at the University of Pittsburgh. The response was gratifying – thousands of young people attended, and learned about preventive care of their hearts. Maggie Dixon died unexpectedly of heart disease at age 28 and was the sister of Pitt coach Jamie Dixon.

Heart disease is not an inevitable aspect of aging; it is largely preventable through regular screenings and living a healthy lifestyle. The lifestyle modifications that can help prevent heart attack or stroke also improve overall health, quality of life and longevity: 1) smoking cessation; 2) weight loss; 3) heart healthy eating; and 4) physical activity. Even moderate changes in these areas can be effective, and there are many resources that can be helpful. Developing healthy habits doesn't require drastic measures; simple modifications and awareness of risk factors are the keys.

"If we can identify someone, through screenings, with early evidence of plaque and we educate that person and support them as they implement the recommended lifestyle changes, it can change the course of their life," says Dr. Edmundowicz. "It's a powerful tool for preventing a heart attack or stroke."

Use this link for more information, or to find a screening event near you

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