Health Matters: Questions about arteries
Q. What screening tests are available to look for hardening of the arteries in a person like me who has no symptoms?
A. Let's start with what we mean by "hardening of the arteries."
This occurs as we age when cholesterol and similar substances get deposited in the walls of blood vessels (the arteries) in the body. Calcium, the mineral in bone, also gets deposited, and the combination of the two leads to thickening and stiffening of the arteries — that is, hardening.
Screening tests to look for this change should be used just as you suggest — to look for disease in people who don't have other evidence of disease. So people with symptoms don't need screening tests; they already have evidence of disease and need to be treated.
But for screening tests to be useful in people like you without symptoms, they need to be able to meet two goals — detect disease early (before it causes problems) and lead to treatment that improves the health of patients by preventing complications before they occur. As a general rule, most screening tests looking for hardening of the arteries are better at the first goal than the second — that is, they are better at uncovering early disease than being useful for improving patient outcomes.
Screening most often is performed in four areas: in the arteries of the neck (the carotids), the arteries of the heart, the big blood artery in the belly (the aorta), and the arteries going to the legs. But for the majority of people without symptoms, routine screening typically is recommended only to look for an enlarged aorta in the belly, and then mainly in male smokers (present or past) who are 65 to 75 years of age. Why? Because identifying an enlargement of the aorta in those patients significantly reduces the subsequent risk of rupture of the aorta if it is fixed ahead of time. But for the other areas — neck, heart and legs — the evidence of real benefit of screening (that is, the prevention of subsequent problems) is much more uncertain.
Q. What should I do if my doctor tells me that I do have hardening of my arteries?
A. Well, if you have an enlarged aorta, get it fixed pronto — as discussed above. But for most other cases of hardening of the arteries in people without symptoms, you should do what we recommend for all adults — don't smoke; don't be overweight; be sure that your blood pressure is under good control; exercise at least three and preferably five times per week; eat a sensible diet; and take a medicine to lower your cholesterol if you are in a higher-risk group.
We know that doing all these things — although they may be a challenge to do in practice — is the best way to ward off future problems. It turns out that these simple steps work better overall than stents and surgery to prevent future problems. Now that's not to say stents and the like don't have an important and sometimes lifesaving role; they do. But they just aren't as good at preventing problems as are the steps outlined above.
Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.
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