Clinical Preventive Service Recommendation

Coronary Heart Disease

Coronary Heart Disease, Adults

The AAFP recommends against screening with resting or exercise electrocardiography (ECG) for the prediction of coronary heart disease (CHD) events in asymptomatic adults at low risk for CHD events. (2012)

(Grade: D recommendation)
Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm#drec(www.uspreventiveservicestaskforce.org)
Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf11/coronarydis/chdfinalrs.htm#clinical(www.uspreventiveservicestaskforce.org)

Coronary Heart Disease, Adults

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening with resting or exercise ECG for the prediction of CHD events in asymptomatic adults at intermediate or high risk for CHD events. (2012)

(Grade: I recommendation)
Grade Definition:http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm#irec (www.uspreventiveservicestaskforce.org)
Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf11/coronarydis/chdfinalrs.htm#clinical(www.uspreventiveservicestaskforce.org)

Coronary Heart Disease Risk Assessment, Using Nontraditional Risk Factors

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of using the nontraditional risk factors discussed in this statement to screen asymptomatic men and women with no history of CHD to prevent CHD events. (Select "Clinical Considerations" for suggestions for practice when evidence is insufficient).

The nontraditional risk factors included in this recommendation are high-sensitivity C-reactive protein (hs-CRP), ankle-brachial index (ABI), leukocyte count, fasting blood glucose level, periodontal disease, carotid intima-media thickness (carotid IMT), coronary artery calcification (CAC) score on electron-beam computed tomography (EBCT), homocysteine level, and lipoprotein(a) level. (2010)

(Grade: I recommendation)
Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm(www.uspreventiveservicestaskforce.org)
Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf/uspscoronaryhd.htm(www.uspreventiveservicestaskforce.org)


These recommendations are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute for the individual judgment brought to each clinical situation by the patient's family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These recommendations are only one element in the complex process of improving the health of America. To be effective, the recommendations must be implemented.