I Heart My Heart - Part 1: Preventive Screenings for Cardiovascular Disease

Cardiovascular disease is the #1 cause of death in the US, at about 655,000 deaths/year.¹ Even more importantly, it is estimated that nearly ⅓ of deaths from cardiovascular disease are preventable.²

For this reason, the United States Preventive Services Task Force has made six separate recommendations for clinical preventive services. Two of these recommendations are screenings for risk factors of cardiovascular disease, two are for medications that decrease cardiovascular risk, and then the final two are about behavioral counseling and interventions that also reduce risk.

Let’s start with the two screening recommendations. The first of these is to screen any adult, (any person over the age of 18), for high blood pressure (also known as “hypertension”).³ This condition is very common, with approximately 45% of American adults affected.⁴ It’s also a very sneaky condition, as most of the time hypertension doesn’t cause any symptoms. It is often called the “silent killer“, as many people who have high blood pressure don’t know it. Despite not causing symptoms, it is a major risk factor for heart attacks, strokes, chronic kidney disease, and heart failure.⁵

You’ve probably already noticed that every time you go in to the doctor's office do you have your blood pressure taken. One of the main reasons why is to screen you for hypertension.

There is strong evidence that screening for high blood pressure significantly reduces the incidence of cardiovascular events when those who have this condition are placed on proper treatment.³ It’s also generally a very safe, inexpensive screening test. 

But one thing to consider is that when you only have your blood pressure checked in the office, that is just one "snapshot" in time. People who would like to be more proactive about this screening can get their own blood pressure cuff and check it at home more frequently. This technology has significantly developed over the past couple of decades, and automated blood pressure devices are becoming more accurate, convenient, and technologically advanced all the time. I encourage my patients to own a device for self blood pressure monitoring. This helps people become more actively invested in their cardiovascular health, and also provides considerably more data points compared to just that "snapshot" blood pressure from the office. So in summary, the main purpose of this screening recommendation is that if you have hypertension, it’s really important that you know and intervene when appropriate to mitigate this risk.

The second screening test recommended is checking for abnormal blood glucose in individuals age 40 to 70 who are either overweight or obese.⁶ Abnormal glucose metabolism is a major risk factor for cardiovascular disease⁷, and identifying this disease process early on is crucial so that appropriate interventions can be implemented; specifically intensive behavioral counseling to promote healthful diet and physical activity.⁶ The goal is that emphasizing these elements of healthy lifestyle will prevent progression to type 2 diabetes and cardiovascular disease. 

There are a few different acceptable tests that can be used to screen for abnormal blood glucose, including a fasting blood glucose, an oral glucose tolerance test (where you’d drink a sugary drink and then assess how your body responds to it), or hemoglobin A1c, which essentially measures what your average blood glucose has been over the past 90 days. They are all simple and safe, with the only potential “harm” being short-term anxiety when awaiting the test results.⁸ And there is good evidence that the benefits outweigh the harms. So once again, this screening, for abnormal glucose, is for people aged 40-70 who are overweight or obese, meaning a BMI over 25.

In part 2 of The Health Confidence Academy's article on preventive clinical services for cardiovascular disease, preventive medications and counseling recommendations will be discussed. Be sure to read that article, and pass both Part 1 and Part 2 on to someone you know and love, and help to protect their heart. 

References:

1. Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics—2020 update: a report from the American Heart Association. Circulation. 2020;141(9):e139–e596.
2. García MC, Bastian B, Rossen LM, et al. Potentially Preventable Deaths Among the Five Leading Causes of Death — United States, 2010 and 2014. MMWR Morb Mortal Wkly Rep 2016;65:1245–1255.
3. Albert L. Siu, MD, MSPH, on behalf of the U.S. Preventive Services Task Force. Screening for High Blood Pressure in Adults: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine. November 2015.
4. Ostchega Y, Fryar C, Nwankwo T, Nguyen DT. Hypertension Prevalence Among Adults Aged 18 and Over: United States, 2017–2018. 2020. https://www.cdc.gov/nchs/products/databriefs/db364.htm. Accessed October 8, 2020.
5. Piper MA, Evans CV, Burda BU, Margolis KL, O'Connor E, Smith N, et al. Screening for High Blood Pressure in Adults: A Systematic Evidence Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 121. AHRQ Publication No. 13-05194-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2014.
6. Albert L. Siu (on behalf of the USPSTF). Screening for Abnormal Blood Glucose and Type 2 Diabetes Mellitus: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine 2015 163:11, 861-868. 
7. Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion. National Diabetes Statistics Report, 2014. Atlanta: Centers for Disease Control and Prevention; 2014.
8. Park P, Simmons RK, Prevost AT, Griffin SJ. Screening for type 2 diabetes is feasible, acceptable, but associated with increased short-term anxiety: a randomised controlled trial in British general practice. BMC Public Health. 2008;8:350.