Screening for Coronary Heart Disease (CHD)

Coronary Heart Disease (CHD) refers to a spectrum of heart diseases that result from damaged arteries of the heart. Angina pectoris (a.k.a. cardiac chest pain), unstable angina, ischemic heart disease, ischemic cardiomyopthy, and myocardial infarction (a.k.a. heart attack) are common variants of CHD. Atherosclerosis is a main cause of CHD.

CHD remains the leading cause of death in adults; many patient had sudden death as very first clinical symptom. A Framingham Heart Study concluded that lifetime risk of CHD for men and women aged 40 was 49% and 32% respectively. These men and women did not have any CHD at the beginning of this study [Lancet 1999 Jan 9;353(9147):89-92].

Since CHD may already exist in many individuals who do not have any symptoms, there is great interest in detecting this disease at its early stages, a.k.a. screening. There are various recommendations from different groups of experts with regard to CHD screening. Even though there is no unanimous consensus on it, asymptomatic people with high risks of CHD will benefit from screening. High risks of CHD are:

• Cigarette smoking


• Diabetes mellitus


• Cholesterol > 250mg/dl


• Systolic blood pressure > 140mmHg or diastolic blood pressure > 90 mmHg


• Family members who have heart attacks or die of sudden cardiac death under age 60
  

There exist several screening tests, none of which is perfect. Considering cost and easy accessibility, exercise ECG test is likely the best one.