Screening low-risk individuals for coronary artery disease
Related Experiment Video
Updated: May 3, 2026
Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
Chintan S Desai1, Roger S Blumenthal, Philip Greenland
1Johns Hopkins Hospital, Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA, cdesai6@jhmi.edu.
Insights
Many cardiovascular events occur in "low-risk" individuals. While coronary artery calcium (CAC) and ankle-brachial index (ABI) show promise for improved risk assessment, routine screening is not recommended currently.
Area of Science:
- Cardiology
- Preventive Medicine
- Medical Diagnostics
Background:
- A significant number of cardiovascular events occur in individuals deemed low-risk by traditional factors.
- This highlights a need for improved early detection and risk assessment strategies in this population.
- Existing risk factors may underestimate the true cardiovascular risk for many individuals.
Purpose of the Study:
- To evaluate the utility of additional diagnostic tests for improving cardiovascular risk assessment in low-risk individuals.
- To explore the potential of coronary artery calcium (CAC) score, ankle-brachial index (ABI), and high-sensitivity C-reactive protein (hsCRP) in this context.
Main Methods:
- Review of existing data on the effectiveness of CAC, ABI, and hsCRP in low-risk populations.
- Analysis of the potential impact of these tests on risk classification and early detection of coronary artery disease.
Main Results:
- Coronary artery calcium (CAC) and ankle-brachial index (ABI) show potential for improving risk classification among low-risk individuals.
- These tests may help identify higher-risk individuals within the broader low-risk group.
- Data supporting the routine use of these additional tests in low-risk populations remain sparse.
Conclusions:
- While CAC and ABI show promise for enhanced risk stratification, routine use is not currently recommended for low-risk individuals.
- Further clinical trials are needed to establish the definitive role and efficacy of these tests in this population.
- Current evidence does not support widespread screening with CAC, ABI, or hsCRP in asymptomatic low-risk individuals.
Abstract:
A large proportion of cardiovascular events occur in individuals classified by traditional risk factors as "low-risk." Efforts to improve early detection of coronary artery disease among low-risk individuals, or to improve risk assessment, might be justified by this large population burden. The most promising tests for improving risk assessment, or early detection, include the coronary artery calcium (CAC) score, the ankle-brachial index (ABI), and the high-sensitivity C-reactive protein (hsCRP). Data regarding the role of additional testing in low-risk populations to improve early detection or to enhance risk assessment are sparse but suggest that CAC and ABI may be helpful for improving risk classification and detecting the higher-risk people from among those at lower risk. However, in the absence of clinical trials in this patient population, such as has recently been proposed, we do not recommend routine use of any additional testing or screening in low-risk individuals at this time.
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