Tests for a silent killer
DESPITE WIDESPREAD testing for high levels of cholesterol and blood pressure, heart disease is a silent killer that often strikes individuals who have not been identified as at risk. In 30 percent to 50 percent of patients with severe hardening of the arteries, their first symptom is an acute, often fatal, heart attack. Medicine ought to be able to do better at detecting this disease and helping patients keep it from progressing.
Two imaging scans that would provide more evidence of early trouble were touted for more routine use recently in a supplement to the American Journal of Cardiology. The supplement raised eyebrows in medical-ethics circles because it was financially supported by
Pfizer's involvement is worrisome, but it should not eclipse the core question: Would regular use of these scans improve treatment of heart disease and save lives? The supplement's physician-authors believe it would, and propose age and risk-category guidelines that would qualify 50 million Americans for testing, at a cost pegged between $250 and $750 for both scans.
Before society makes that large an investment, however, it should have better evidence to go on, and this is the real problem. The National Institutes of Health doesn't want to undertake the considerable expense of doing a study that would show whether use of the scans on individuals who are not considered to be at high risk of heart disease would actually prevent heart attacks and deaths.
And yet this would seem to be just the kind of research that the NIH's National Heart, Lung, and Blood Institute, which doesn't have a financial conflict like Pfizer's, should be doing. Although a study of the scans' effectiveness would be costly, said Dr. Robert Bonow, past president of the American Heart Association and professor of medicine and chief of cardiology at Northwestern University, ``it would be worthwhile to develop a trial to see if this changes behavior and outcomes."
Changing behavior is important because heart health depends so heavily on individuals following doctors' advice on smoking cessation, diet, exercise, and regular use of medications like the cholesterol-lowering statin drugs.
There is conflicting evidence on whether individuals are more likely to follow doctors' orders after they learned from scans that they have serious underlying problems.
A good, long-term NIH study that compares a large sample of scanned patients with a large sample of unscanned patients would answer this and other questions before medicine embarks on a new regime of testing. ``We need more science," Bonow said. The NIH is the agency to provide it in the effort to better treat the nation's No. 1 killer.
