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Cardiovascular screening in Army personnel over age 40 in the State of Hawaii
D C Wortham1, L W Jordan, S L Jones
1Cardiology Clinic, Tripler Army Medical Center, Honolulu, Hawaii.
Insights
This study screened 1,900 soldiers over 40 for latent coronary artery disease. Combining a positive treadmill test with fluoroscopy findings accurately identified obstructive coronary artery disease.
Area of Science:
- Cardiology
- Preventive Medicine
- Diagnostic Imaging
Background:
- Latent coronary artery disease poses a significant risk in middle-aged populations.
- Early identification of coronary artery disease is crucial for timely intervention.
- Current screening methods have varying degrees of effectiveness.
Purpose of the Study:
- To evaluate a prospective cardiovascular screening protocol for soldiers over 40.
- To identify individuals with latent coronary artery disease.
- To assess the predictive value of combined screening methods for obstructive coronary artery disease.
Main Methods:
- Prospective screening of 1,900 soldiers (>40 years) using primary (history, exam, ECG, labs, Framingham risk) and secondary (stress test, fluoroscopy) methods.
- Coronary angiography performed on 43 individuals.
- Bayes' theorem used to calculate expected probabilities.
Main Results:
- Primary screening identified 796 individuals for secondary screening.
- Coronary angiography revealed 17 obstructive, 10 nonobstructive CAD, and 16 normal arteries.
- Positive treadmill test combined with fluoroscopic coronary artery calcification showed high predictive value for obstructive coronary artery disease (50% post-test probability).
Conclusions:
- The implemented cardiovascular screening protocol effectively identifies soldiers at risk for coronary artery disease.
- Combining primary screening with exercise testing significantly increases the diagnostic yield.
- Fluoroscopy and treadmill testing together are excellent predictors of obstructive coronary artery disease.
Abstract:
A cardiovascular screening protocol was applied prospectively to 1,900 soldiers over 40 years of age to identify individuals with latent coronary artery disease. Primary screening included a cardiovascular history, physical examination, electrocardiogram, serum cholesterol and serum glucose determinations, and calculated Framingham risk index. Seven hundred ninety-six individuals required secondary screening, consisting of stress testing and cardiac fluoroscopy. The screening process led to coronary angiography in 43 individuals; of these, 17 had obstructive coronary artery disease, ten had nonobstructive coronary artery disease, and 16 had normal coronary arteries. Application of primary screening before exercise testing increased the posttest probability of obstructive coronary artery disease to 50% in the individuals with a positive treadmill test. This is four times the expected value of 11% calculated using Bayes' theorem. The combination of a positive treadmill test and the finding of coronary artery calcification on fluoroscopy was an excellent predictor of obstructive coronary artery disease.