MEDICINE&SCIENCE
More at won’t come swiftly, as doctors and insurers may balk at imaging and medicating so many more people. Stress tests cost $200 to $500. CT scans cost $400 to $600 and MRIs can cost more than $800, Zadeh said.
Some cardiologists, however, already use CT scans to get a less invasive look at patients who may be at risk and may benefit from earlier treatment. The new rankings may push more to follow suit, said Dr. John Osborne, a Dallas cardiologist and a volunteer spokesman for the American Heart Association.
He said cardiologists know stress tests aren’t picking up all those at risk for heart attacks, but they don’t want to subject patients to catheterization, which involves threading a catheter through an artery or vein in the groin, neck or arm leading to the heart. Doctors also may be dismissing more women with heart disease because their symptoms may be less severe or specific.
CT scans and MRIs are newer technologies than X-ray catheterizations sensitive enough to assess the level of blockages, allowing doctors to get a look at more patients’ vessels. Those with 30 percent or 40 percent blockages — Osborne called it “lumpy bumpy” disease — may benefit from daily aspirin or statins, which he said were considered relatively safe for long-term use.
“It’s certainly not the first time anyone has thought of this,” Osborne said of the lower thresholds for treating patients. “The advantage is this comes from respected institutions and the staging system creates a better way to describe the disease in these individuals.”
While Osborne believes the benefits outweigh concerns in lowering the bar for scanning and medicating more patients, other doctors aren’t sure they’re ready to make changes. Among them is Dr. Michael Miller, a professor of cardiovascular medicine, epidemiology and public health at the University of Maryland School of Medicine and director of the University of Maryland Medical Center’s Center for Preventive Cardiology.
He agreed that stress tests only pick up high levels of disease, but imaging a lot of people who pass that test would be expensive and perhaps not focused enough on those who are likely to develop problems.
“I’d say not so fast on doing these tests,” Miller said.
He said doctors should use established methods of assessing heart disease risk factors and determine the threat of a future heart attack.
That means looking at blood pressure, cholesterol levels, family history and lifestyle, and determining more narrowly who to scan or medicate.
There also is no evidence yet that medicating people with mild heart disease will prevent heart attacks or death down the road, Miller said. Medications alone may not be effective and may give patients a false sense of health, he said.
Miller said many patients would really benefit from changes to diet, exercise and stress levels. He wrote a book called “Heal Your Heart” that focuses on stress reduction.
“I wouldn’t necessarily go right to CT scans or MRIs,” he said. “I do a risk score and see if they are in the range I’m worried about. If a patient isn’t sure they want to go on a statin and won’t change their lifestyle, I’d say why don’t we do the scan and let it settle the score.”