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Docs Urged to Gauge
Patients' Heart Disease Risk


NEW YORK (Reuters Health) - Physicians should divide their patients into three groups based on their risk of heart disease, which would help doctors offer appropriate screening tests and preventive treatment to those at moderate and high risk, experts advise.

``A person who is concerned about their potential for heart disease (should) go to their doctor, gauge their risk and if they're at high risk, do something about it,'' co-author Dr. Philip Greenland, a professor of preventive medicine at Northwestern University Medical School in Chicago, Illinois, told Reuters Health. ``We hope physicians will parcel people out into these three categories.''

In the report, published in the October 9th issue of Circulation: Journal of the American Heart Association, the researchers recommend that primary care doctors use assessment methods to divide patients into categories of low, intermediate and high risk of heart disease, based on known risk factors such as smoking, high blood pressure, cholesterol levels, obesity and failing to exercise.

The authors note that if all American adults over age 20 were assessed this way, 35% would fall into the low-risk category, 40% would be at intermediate risk and the remaining 25% would be at high risk.

Dividing patients into these three categories would help doctors stratify which patients require more intensive tests and which would not.

For example, patients assessed to be at low risk of heart disease can be simply assured they are doing well, while patients at high risk would immediately go on for more advanced treatment and prevention methods, such as ACE inhibitors and cholesterol-lowering drugs.

``The people who would benefit from additional testing are those we call intermediate risk,'' Greenland said. ``Those people can neither be reassured nor intensively treated, because they're in this intermediate zone.''

These patients would be the ones who could most benefit from non-invasive assessment methods used to gauge their heart health, as well as to measure the degree of atherosclerosis--or fatty build-up--in their blood vessels, according to Greenland. These tests include ultrasound scans of the carotid arteries in the neck, electron-beam tomography and treadmill stress tests.

Currently, many centers market these tests directly to consumers, who are signing up and paying out of pocket for the tests on their own initiative, rather than being referred by a medical expert, Greenland noted.

``Since there's no doctor involved, they frequently end up going on to additional testing that would be uncalled for,'' he said. ``A lot of people who shouldn't be getting surgery are getting a cascade of things they shouldn't have.

``Patients can do a lot to take care of themselves,'' Greenland said. ``But I think when you start getting into who is an appropriate candidate for testing, a doctor should be part of that equation.''

Greenland also criticized those who have suggested that patients have no need for such tests in the absence of suffering a heart attack or having established heart disease.

``A guideline that says that no patient should ever have a non-invasive test looking for the early presence of heart disease in the pre-symptomatic stage is inappropriate,'' Greenland said. ``There are data for which kinds of patients would benefit from these kinds of tests.''

SOURCE: Circulation 2001;104:1863-1867.


Reference Source 89

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