What's behind the ratings for heart screening tests?

We rated 10 medical tests that screen for cardiovascular disease. We focused on their effectiveness, benefits, and value for people without symptoms of the disease. The Rating for each screening test can differ depending on a person's age, gender, and overall risk of developing cardiovascular disease.

We chose these 10 because they are commonly available and the evidence for each had been previously reviewed by the U.S. Preventive Services Task Force, an independent group supported by the U.S. Department of Health and Human Services that develops recommendations on preventive health care, including screening tests. For each test, we evaluated five factors, which together gave a potential total score of 100 points.

1. U.S. Preventive Services Task Force grade

The panel reviewed the scientific evidence on each test and assigned it a grade, which we then used in our Ratings, as shown below:

2. Additional evidence

We assigned up to 10 points if we found substantial additional evidence about a test's effectiveness beyond what was considered by the task force. Because screening tests that received an A grade from the panel already have substantial support, we did not look for additional evidence.

3. Disease burden

We assigned up to 20 points based on the number of people likely affected by the form of cardiovascular disease potentially detected by the test.

4. Value

We assigned up to 20 points depending on a test's value, as determined by these three components:

• The cost of the test itself, mainly from HealthcareBlueBook.com (up to 6 points).
• The cost of treating the disease if it's detected, based on a likely treatment plan with lifestyle changes, prescription medication, and in some cases, surgery or other procedures (up to 6 points). Drug-cost estimates came from our Best Buy Drugs reports. Other treatment costs generally came from HealthcareBlueBook.com.
• Cost effectiveness based on independent analyses of the likely improvement in a patient's quality of life from being tested and treated (up to 8 points).

5. Additional benefits

We assigned up to 10 points if we determined that a test offered additional health benefits beyond its cardiovascular ones.

The total score for each test was converted to our Ratings, as shown below.

Points	Rating	What the Rating means
81-100		The benefits very likely outweigh the risks.
61-80		The benefits likely outweigh the risks.
41-60		It's uncertain whether the benefits outweigh the risks.
21-40		The benefits are unlikely to outweigh the risks.
0-20		The benefits are very unlikely to outweigh the risks.

This project was made possible in part by a grant from the New York State Attorney General on behalf of Attorneys General of all 50 states, the District of Columbia, and Puerto Rico, from litigation-settlement funds to benefit the health-care needs of consumers with high blood pressure and angina.

We rated screening for high blood pressure, or hypertension, in people with no symptoms and no history of cardiovascular disease.

Our Rating is based mainly on recommendations from the U.S. Preventive Services Task Force, an independent group supported by the U.S. Department of Health and Human Services that develops recommendations on preventive health care, including screening tests. In addition, we considered three other factors:

• Disease burden: How many people in the U.S. have hypertension?
• Value: What is the cost of screening and treatment, and is screening cost-effective for individuals?
• Additional benefits: Does diagnosing and treating hypertension offer any health benefits beyond its cardiovascular ones?

Overall Rating

We gave blood-pressure screening our highest Rating () for all men and women. That means the benefits very likely outweigh the risks. It should be a top priority for all adults, even if previous readings were normal. Screening should start at 18 and occur at least every two years.

Read more about how to increase the accuracy of blood-pressure screenings, and what to do if your levels are elevated.

Task Force grade

The task force gave screening for high blood pressure an A, which means the test offers substantial benefits. The evidence for it is strong and has been confirmed over many years with different research methodologies. The likelihood of evidence emerging to the contrary is small. As a result, we did not look for more.

Disease burden

Hypertension is the most common risk factor for heart disease and strokes in the U.S. and the country's second most common cause of disability. Thirty percent of the people in the U.S. with the condition don't know they have it, and 65 percent of those with it aren't adequately treated. People can develop high blood pressure at any age, but the risk increases as we grow older. Eighty to 90 percent of people who have normal blood pressure at 55 will have high blood pressure in their 80s or 90s.

Value

The test to measure blood pressure is inexpensive and widely available, often at no or minimal cost. Once diagnosed, cost of treatment is limited to office visits with a health-care provider and usually prescription drugs, many of which are available as low-cost generics. In some cases, weight loss, exercise, and dietary changes can successfully treat hypertension. As a result, screening for high blood pressure is extremely cost effective.

Additional benefits

Detection and treatment of hypertension results in significant benefits beyond those related to cardiovascular disease. The condition can contribute to kidney failure and vision loss. And people motivated to lose weight, exercise more, and eat better might reduce their risk of developing diabetes and other health problems.

We rated screening for high levels of LDL (bad) cholesterol and low levels of HDL (good) cholesterol in people with no symptoms and no history of cardiovascular disease.

Our Rating is based mainly on recommendations from the U.S. Preventive Services Task Force, an independent group supported by the U.S. Department of Health and Human Services that develops recommendations on preventive health care, including screening tests. In addition, we considered four other factors:

• Additional evidence: Has research published since the task force's last recommendation changed the advice?
• Disease burden: How many people in the U.S. have abnormal cholesterol levels?
• Value: What is the cost of screening and treatment, and is screening cost-effective for individuals?
• Additional benefits: Does diagnosing and treating abnormal cholesterol levels offer any health benefits beyond its cardiovascular ones?

Overall Rating

Our Ratings for cholesterol screening vary depending on age, gender, and risk level:

• For men 35 and older as well as well as women 45 and older who are at high risk of cardiovascular disease, we gave it our highest Rating (). That means the benefits very likely outweigh the risks.
• For men 20 to 34 and women 20 to 44 who are at high risk of cardiovascular disease, we gave it our second highest Rating (). That means the benefits likely outweigh the risks.
• For men 20 to 34 and women 20 and older at low or moderate risk of cardiovascular disease, we gave it our intermediate Rating (). That means it's uncertain whether the benefits outweigh the risks.

Screening for high lipid levels should be a priority for everyone at high risk of heart disease, at all ages. (To determine your cardiovascular risk, use our calculator.) Other people could still consider screening but don't need to make it a priority because the likelihood of abnormal cholesterol levels is lower and the benefits of drug treatment are smaller. When screening is appropriate, it should occur at least every five years.

Read more about how to increase the accuracy of cholesterol screening, and what to do if your levels are abnormal.

Task Force grade

The task force gave cholesterol screening an A (substantial benefit) for men 35 older and women 45 and older at high risk of cardiovascular disease. It gave cholesterol screening a B (moderate to substantial benefit) for men 20 to 34 and women 20 to 44 who are at high risk of cardiovascular disease. And it gave cholesterol screening a C (small benefit) for men 20 to 34 and women 20 and older who are at low or moderate risk of cardiovascular disease.

Additional evidence

We did not look for additional evidence for men 35 and older or women 45 and older at high cardiovascular risk because it was already substantial. For the other groups, we didn't find additional research that warranted making a recommendation that differed from the task force's.

Disease burden

Tens of millions of people in the U.S. have abnormal cholesterol levels and are treating the problem with medication or other measures. Many millions more are probably unaware of their levels. And abnormal levels are likely to become more common as the population ages and more people become overweight.

Value

Measuring cholesterol levels in a doctor's office generally costs about $50. Once diagnosed, cost of treatment is limited to office visits with a health-care provider and usually prescription drugs, many of which are available as low-cost generics. In some cases, weight loss, exercise, and dietary changes can successfully treat abnormal cholesterol levels. As a result, cholesterol screening is cost effective, especially for high-risk people.

Additional benefits

Detection and treatment of abnormal cholesterol levels might result in moderate benefits beyond those related to cardiovascular disease. People motivated to lose weight, exercise more, and eat better might reduce their risk of developing diabetes and other health problems. And some of the drugs used to lower LDL cholesterol might have beneficial anti-inflammatory effects.

We rated screening for type 2 diabetes in people with no symptoms and no history of the condition or cardiovascular disease.

Our Rating is based mainly on recommendations from the U.S. Preventive Services Task Force, an independent group supported by the U.S. Department of Health and Human Services that develops recommendations on preventive health care, including screening tests. In addition, we considered four other factors:

• Additional evidence: Has research published since the task force's last recommendation changed the advice?
• Disease burden: How many people in the U.S. have type 2 diabetes?
• Value: What is the cost of screening and treatment, and is screening cost-effective for individuals?
• Additional benefits: Does diagnosing and treating type 2 diabetes offer any health benefits beyond preventing cardiovascular disease?

Overall Rating

Our Ratings for diabetes screening vary depending on risk level:

• For people at increased risk—those with a systolic (upper) blood pressure level over 135 millimeters of mercury (mmHg) or a diastolic (lower) level over 80 mm/Hg; an LDL (bad) cholesterol level over 130 millimeters per deciliter; or excessive weight (a body mass index of 30 or more)—we gave it our second highest Rating (). That means the benefits of diabetes screening likely outweigh the risks.
• For people without those risk factors, we gave it our intermediate Rating (). That means it's uncertain whether the benefits outweigh the risks for them.

Screening for type 2 diabetes should be a priority for everyone with one or more of the risk factors listed above. Other people could still consider screening but don't need to make it a priority because the likelihood of abnormal blood sugar levels is lower for them and the benefits of drug treatment are less clear. When screening is appropriate, it should occur at least every three to five years.

Read more about how to increase the accuracy of blood glucose screening and how to prevent and control diabetes.

Task Force grade

The task force gave screening for type 2 diabetes a B (moderate to substantial benefit) for people with a systolic blood pressure over 135 mmHg or a diastolic pressure over 80 mmHg. For other people, the panel gave the screening an I, which means that it found insufficient evidence to make a recommendation.

Additional evidence

We found additional evidence suggesting that screening for type 2 diabetes is also reasonable for adults who are obese or have a high LDL cholesterol level. The growing number of people who are at risk for the condition because of advancing age, obesity, or inactivity provides a further reason for our more aggressive recommendation on screening.

Disease burden

Tens of millions of people in the U.S. have type 2 diabetes, and it's especially common as people age. And the problem is going to become more common as the population ages and obesity increases. The condition often does not cause symptoms until it's advanced, so many people are unaware they have it. For people with diabetes, aggressively controlling their blood pressure and cholesterol levels can decrease the risk of having a heart attack or stroke.

Value

Measuring blood glucose levels generally costs about $20 to $30. Once type 2 diabetes is diagnosed, the cost of treatment includes office visits with a health-care provider, lifestyle changes, and prescription drugs, some of which are available as low-cost generics. As a result, diabetes screening is cost effective for high-risk people.

Additional benefits

Detection and treatment of type 2 diabetes might result in significant benefits beyond those related to cardiovascular disease. The condition increases the risk of kidney disease, vision problems, and nerve disorders, and early detection can help prevent them. And people motivated to lose weight, exercise more, and eat better might reduce their risk of other health problems. Detection and treatment can also reduce other symptoms from uncontrolled type 2 diabetes.

We rated screening for elevated levels of C-reactive protein (CRP) in people with no symptoms or history of cardiovascular disease. CRP is a marker of inflammation in the body, including the arteries.

Our Rating is based mainly on recommendations from the U.S. Preventive Services Task Force, an independent group supported by the U.S. Department of Health and Human Services that develops recommendations on preventive health care, including screening tests. In addition, we considered four other factors:

• Additional evidence: Has research published since the task force's last recommendation changed the advice?
• Disease burden: How many people in the U.S. have inflammation that affects their heart that can be detected from CRP?
• Value: What is the cost of screening and treatment, and is screening cost-effective for individuals?
• Additional benefits: Does diagnosing and treating inflammation offer any health benefits beyond preventing heart disease?

Overall Rating

Our Rating of CRP screening varies depending on risk level (To determine your risk, use our calculator.)

• For people at moderate risk of cardiovascular disease, we gave it our intermediate Rating (). That means it's uncertain whether the benefits outweigh the risks for them.
• For people at low or high risk of cardiovascular disease, we gave it our second lowest Rating (). That means the benefits are unlikely to outweigh the risks for them.

Screening for inflammation should not be a priority for most people, even those at high or low risk of heart disease. That's because for them, learning their CRP is unlikely to affect treatment decisions. But people at moderate risk of heart disease might consider screening because for them, an elevated CRP level might warrant more aggressive treatment of other coronary risk factors, notably elevated levels of LDL (bad) cholesterol and possibly the use of low-dose aspirin.

Read more about how to make CRP screening accurate, and what to do if your CRP is elevated.

Task Force grade

The task force gave CRP screening an I, which means it found insufficient evidence to make a recommendation.

Additional evidence

We found additional evidence suggesting that CRP screening might help people at moderate risk of heart disease determine how aggressively they should treat other risk factors, notably high LDL cholesterol levels. But some of that research is controversial, in part because one important study was sponsored by a drug company and was written by an individual who holds a patent on one form of CRP testing.

Burden of disease

High CRP levels are common, though in many cases they stem not from inflamed coronary arteries but inflammation elsewhere in the body, such as from an injury, infection, or a chronic disease like rheumatoid arthritis. Moreover, it is likely that only a smaller portion of the population, those at intermediate risk for heart disease, can benefit from the test.

Value

Measuring CRP generally costs about $25 to $50. If elevated levels are detected, the cost of treatment is often limited to office visits with a health-care provider and possibly lifestyle changes and prescription drugs, some of which are available as low-cost generics. But because the benefits of screening are still uncertain, it's unknown whether it's cost-effective.

Additional benefits

While high CRP levels can indicate other inflammatory conditions, such as an infection or injury, measuring it is generally not helpful for diagnosing or treating those conditions. But people motivated to lose weight, exercise more, and eat better might reduce their risk of other health problems.

We rated screening for clogged arteries in the legs in people without symptoms (such as pain when walking) or a history of the problem.

Our Rating is based mainly on recommendations from the U.S. Preventive Services Task Force, an independent group supported by the U.S. Department of Health and Human Services that develops recommendations on preventive health care, including screening tests. In addition, we considered four other factors:

• Additional evidence: Has research published since the task force's last recommendation changed the advice?
• Disease burden: How many people in the U.S. have peripheral artery disease?
• Value: What is the cost of screening and treatment, and is screening cost-effective for individuals?
• Additional benefits: Does diagnosing and treating peripheral artery disease offer any health benefits beyond preventing pain and damage in the legs?

Overall Rating

We gave screening for peripheral artery disease (PAD) in people without symptoms our second lowest rating (). That means that it's unlikely that the benefits outweigh the risks for those people.

Screening for peripheral artery disease should not be a priority for most people without symptoms of the problem. Diagnosing and treating high blood pressure, high cholesterol levels, and diabetes are more effective, along with stopping smoking and taking low-dose aspirin.

Screening tests for peripheral artery disease include comparing blood pressure in the legs with pressure in the arms, or using an ultrasound to measure blood flow. While the tests themselves are safe and don't expose you to radiation, the results can be misleading and lead to more invasive tests and procedures. People at high risk for the problem because of such factors as high blood pressure or high cholesterol levels should watch for symptoms of the condition, such as pain when walking, slow healing of cuts and scrapes, or the appearance of sores that don't heal quickly or completely.

Task Force grade

The task force gave screening for peripheral artery disease a D, which means it found that the risks outweighed the benefits for people without symptoms of the problem.

Additional evidence

While we found some research suggesting that improved techniques might eventually reduce risks of screening for peripheral artery disease, we didn't find evidence to warrant changing the task force's advice now. And while the task force recently considered whether screening for peripheral artery disease also helped predict the risk of developing heart disease, it found insufficient evidence to encourage the test on that basis.

Burden of disease

While peripheral artery disease is common, most people with it also have other risk factors—such as high blood pressure and high cholesterol levels, diabetes, or smoking—that are more easily detected and treated.

Value

Screening tests comparing blood pressure in the arms and legs are inexpensive. An ultrasound often costs less than $100, although it can be more when done in a hospital or other health-care facility. And the cost of a follow-up CT scan or other test to confirm a worrisome ultrasound can be $1,000 or more. Treatment can include drugs or, in some cases, surgery, which can cost several thousand dollars. Research suggests that screening for peripheral artery disease is not cost-effective when done for people without symptoms of the problem.

Additional benefits

The tests might motivate some people to stop smoking, lose weight, exercise more, or eat better, all of which can improve health in multiple ways.

We rated screening for heart disease in people without symptoms of heart problems using an electrocardiogram (EKG) or exercise stress test.

Our Rating is based mainly on recommendations from the U.S. Preventive Services Task Force, an independent group supported by the U.S. Department of Health and Human Services that develops recommendations on preventive health care, including screening tests. In addition, we considered four other factors:

• Additional evidence: Has research published since the task force's last recommendation changed the advice?
• Disease burden: How many people in the U.S. have heart disease that could be detected by an EKG or exercise stress test?
• Value: What is the cost of screening and treatment, and is screening cost-effective for individuals?
• Additional benefits: Do EKGs or exercise stress tests offer any health benefits beyond preventing heart disease?

Overall Rating

Our Ratings for screening for heart disease with an EKG, exercise stress test, or both vary depending on risk level.

• For people at high risk of heart disease we gave it our second lowest Rating
  (). That means it's unlikely that the benefits outweigh the risks for them.
• For people at low or moderate risk of heart disease we gave it our lowest Rating (). That means it's very unlikely the benefits outweigh the risks for them.

An EKG, which measures the heart's electrical activity, and an exercise stress test, which measures the heart's performance during exercise, can help people with symptoms of heart disease, such as chest pain, determine how serious the problem is and whether treatment, such as angioplasty or bypass surgery, is necessary. But the tests have little value for other people and should not be a priority. For them, measuring blood pressure and cholesterol levels is a much more effective way to detect and prevent cardiovascular disease.

Read more about when EKGs and exercise stress tests are appropriate.

Task Force grade

The task force gave EKGs and exercise stress tests a D (risks outweigh the benefits) for people at low or moderate risk of heart disease, and an I (insufficient evidence) for people at high risk.

Additional evidence

We found no additional evidence that warranted making a recommendation that differed from the task force's.

Disease burden

Heart disease affects many people, but most of those at high risk can be adequately identified through simpler screening tests, such as those for high blood pressure or high cholesterol levels.

Value

An EKG generally costs about $50 and an exercise stress test between $200 and $300. Abnormal EKGs and stress tests often require expensive follow-up tests, such as angiography. Screening EKGs and stress tests have not been found to be cost-effective.

Additional benefits

An abnormal EKG or exercise stress test might motivate some people to stop smoking, lose weight, exercise more, or eat better, all of which can improve health in multiple ways.

We rated screening for heart disease in people without symptoms of heart problems using CT angiography, a test that uses multiple X-rays to produce three-dimensional images of the coronary arteries and show blockages. It can also measure the amount of calcium in the coronary arteries, which is associated with those blockages.

Our Rating is based mainly on recommendations from the U.S. Preventive Services Task Force, an independent group supported by the U.S. Department of Health and Human Services that develops recommendations on preventive health care, including screening tests. In addition, we considered four other factors:

• Additional evidence: Has research published since the task force's last recommendation changed the advice?
• Disease burden: How many people in the U.S. have heart disease that could be detected by CT angiography?
• Value: What is the cost of screening and treatment, and is screening cost-effective for individuals?
• Additional benefits: Does CT angiography offer any health benefits beyond preventing heart disease?

Overall Rating

Our Ratings for screening for heart disease with CT angiography depend on your risk level.

• We gave our lowest Rating () for people at low and high risk of heart disease. That means it's very unlikely that the benefits outweigh the risks for them.
• We gave our second lowest Rating () for people at moderate risk of heart disease. That means it's unlikely the benefits outweigh the risks for them.

Screening for heart disease with CT angiography should not be a priority for most people, especially those who are at either low or high risk of heart disease based on standard risk factors such as blood pressure and LDL (bad) cholesterol levels. That's because people at high risk should be treated aggressively with drugs and lifestyle changes regardless of the results of CT angiography. And for people at low risk, an abnormal CT angiogram doesn't usually increase risk enough to justify treatment.

People at moderate risk of heart disease might benefit from CT angiography, since it could help them determine how aggressively they should treat other coronary risk factors, such as high blood pressure or cholesterol levels. But more research is needed to confirm that possible benefit. In addition, CT angiography exposes people to high doses of potentially harmful radiation and can produce false positive results that lead to unnecessary follow-up tests and treatment.

CT angiography is also sometimes used to help people with symptoms of heart disease, such as chest pain, determine how serious the problem is and whether treatment such as angioplasty or bypass surgery is necessary. But the benefit even for them is uncertain, since they almost always need simpler tests first, including an electrocardiogram and stress test and, if those results are uncertain, standard angiography afterward.

Read more about CT angiography.

Task Force grade

The task force gave CT angiography an I, which means it found insufficient evidence to make a recommendation.

Additional evidence

Most of it focused on the potential risks of CT angiography, especially exposure to high doses of radiation.

Disease burden

Heart disease affects many people, but most of those at high risk can be adequately identified through simpler screening tests, such as those for high blood pressure or high cholesterol levels, as well as their personal and family medical histories. Results from CT angiography change the treatment approach of only a small portion of people at moderate risk.

Value

CT angiography generally costs about $500 to $600. Abnormal results often require expensive follow-up tests, such as conventional angiography, which can cost more than $1,000, and sometimes lead to treatment, including surgery, which can cost more than $10,000. And because the benefits of screening are still uncertain it's unknown whether it's cost effective.

Additional benefits

CT scans of the heart might reveal other health problems, such as cancers in the esophagus and lungs. But they can also produce false positive results that trigger unnecessary additional tests and even treatment. Moreover, CT angiography exposes people to radiation, which increases the risk of cancer.

We rated ultrasound screening for abdominal aortic aneurysms, a ballooning of the main artery that carries blood from the heart to the lower body, in people who don't have any symptoms or a history of aneurysms or cardiovascular disease. The aneurysms can be fatal if they burst.

Our Rating is based mainly on recommendations from the U.S. Preventive Services Task Force, an independent group supported by the U.S. Department of Health and Human Services that develops recommendations on preventive health care, including screening tests. In addition, we considered four other factors:

• Additional evidence: Has research published since the task force's last recommendation changed the advice?
• Disease burden: How many people in the U.S. get abdominal aortic aneurysms?
• Value: What is the cost of screening and treatment, and is screening cost-effective for individuals?
• Additional benefits: Does diagnosing and treating an aneurysm offer any health benefits beyond treating the aneurysm itself?

Overall Rating

Our Ratings for screening for abdominal aortic aneurysms depend on age, gender, and smoking status.

• For men 65 and older who have smoked 100 cigarettes or more in their lifetimes, we gave it our second highest Rating (). That means the benefits likely outweigh the risks.
• For men 65 and older who have smoked less than 100 cigarettes in their lifetimes, we gave it our intermediate Rating (). That means it's uncertain whether the benefits outweigh the risks.
• For men 65 and younger and all women, we gave it our lowest Rating (). That means it's very unlikely that the benefits outweigh the risks.

Screening for abdominal aortic aneurysms should be a priority for men 65 and older who have smoked 100 or more cigarettes in their lifetime. In those people, the risk of developing an aneurysm is high. Men in that age group who are not current or former smokers could also consider screening but don't need to make it a priority because their chance of having the problem is lower and the benefits of treatment—usually major surgery to open up the abdominal cavity and repair the aorta—are less certain. Screening is not recommended for other people because the condition is uncommon and the risk of treatment is substantial. When screening is appropriate, a single ultrasound is generally all that's needed unless the scan detects a small aneurysm, in which case follow-up tests are usually necessary.

Treating high blood pressure and cholesterol levels, and stopping smoking can decrease the risk of developing an abdominal aortic aneurysm. In some cases, those steps can also prevent small ones from getting bigger. If an initial test reveals an aneurysm, make sure you get follow-up ultrasounds to ensure it isn't getting larger. It's also important that all testing be done by a qualified provider who's been recommended by a physician. That's because while the test itself is safe and doesn't expose you to radiation, the results can be misleading. If treatment is required, look closely at the qualifications of the surgeon, since some research suggests that results vary significantly.

Task Force grade

The task force gave ultrasound screening for abdominal aortic aneurysms a B (moderate to substantial benefit) for men 65 to 75 who are current or former smokers. Since performing emergency surgery on an aneurysm that has already ruptured is rarely successful, early detection and treatment can be lifesaving. But the risks of elective treatment are also high, since 3 percent to 4 percent of patients die during or soon after the procedure. The task force gave a C (little benefit) to men 65 to 75 who are not current or former smokers, because aneurysms are less common in them. And it gave a D to younger men and all women, because the condition is rare for them.

Additional evidence

While we found some research suggesting that newer surgical techniques might eventually reduce the risk of surgery to repair aortic aneurysms, we found no additional evidence to warrant changing the task force's advice now.

Disease burden

Abdominal aorta aneurysms occur in 1 percent to 3 percent of nonsmoking men 65 and older and 5 percent to 7 percent of current or former smokers. Because aortic aneurysms often cause no symptoms, most people who have the problem don't know it. The condition is much less common in men younger than 65 and in women.

Value

An ultrasound to screen for an abdominal aorta aneurysm often costs less than $100, although it can cost more. And the cost of a follow-up CT scan or other test to confirm a worrisome ultrasound can run $1,000 or more. Treatment usually involves surgery, which can cost several thousand dollars. Research suggests that screening is cost-effective for men 65 to 75.

Additional benefits

The test might motivate some people to stop smoking, lose weight, exercise more, or eat better, all of which can improve health in multiple ways.

We rated ultrasound screening of the carotid arteries (on either side of the neck) to detect narrowing from fatty deposits, which increases the risk of stroke, in people who don't have symptoms of the problem or a history of strokes or mini-strokes (transient ischemic attacks).

Our Rating is based mainly on recommendations from the U.S. Preventive Services Task Force, an independent group supported by the U.S. Department of Health and Human Services that develops recommendations on preventive health care, including screening tests. In addition, we considered four other factors:

• Additional evidence: Has research published since the task force's last recommendation changed the advice?
• Disease burden: How many people in the U.S. have strokes caused by carotid artery disease?
• Value: What is the cost of screening and treatment, and is screening cost-effective for individuals?
• Additional benefits: Does diagnosing and treating carotid artery disease offer any health benefits beyond preventing strokes?

Overall Rating

We gave ultrasound screening of the carotid arteries our lowest Rating () for people who don't have symptoms of clogged carotid arteries. That means it's very unlikely that the benefits outweigh the risks for them.

It shouldn't be a priority for them. Identifying and treating other risk factors for strokes, such as high blood pressure and high cholesterol levels and stopping smoking, is a much more effective way to reduce the risk of strokes. But the test can be worthwhile for people who have a history of strokes or mini-strokes because surgery to clear out the clogged arteries can reduce the risk of having another stroke.

Ultrasound imaging of the carotid is painless, easy to perform, and safe. No radiation exposure is involved. It's often done in mobile clinics instead of in a doctor's office or hospital. Still, while the test itself is unlikely to harm you, the results can be misleading and trigger additional tests and procedures, including risky surgery to clear out clogged arteries.

Task Force grade

The task force gave ultrasound screening of the carotid arteries a D, which means it found that the benefits did not outweigh the risks for people without symptoms.

Additional evidence

While we found some research suggesting that improved surgical techniques might eventually reduce the risk of the procedure sometimes used to treat clogged carotid arteries, we found no evidence to warrant making a recommendation that differed from the task force's.

Disease burden

While strokes are a leading cause of disability and death, only a small fraction of them stem from narrowing of the carotid artery. And while surgery to clear out clogged carotid arteries can help people with a history of strokes or mini-strokes, the procedure is much less effective for people without that history. So only a relatively small number of patients would benefit from widespread screening for carotid disease.

Value

An ultrasound to screen for clogged carotid arteries often costs less than $100, though it can cost more when done at a hospital or other health-care facility. And the cost of a follow-up CT scan or other test to confirm a worrisome ultrasound can be $1,000 or more. Treatment usually involves surgery, which can cost several thousand dollars. Research suggests that screening is not cost-effective for people without symptoms or a history of strokes or mini-strokes.

Additional benefits

The test might motivate some people to stop smoking, lose weight, exercise more, or eat better, all of which can improve health in multiple ways.

Our calculator—which estimates your risk of having a heart attack, stroke, or other cardiovascular event in the next 10 years—is based on on-going research from the Framingham Heart Study. That study began in 1948 by looking at a group of over 5,000 men and women in Framingham, Mass., and has followed them, their children, and their grandchildren ever since. It is one of the largest, longest, and most comprehensive studies of cardiovascular risk available. Framingham researchers have published more than 2,000 scientific studies about their results so far.

The formulas in our calculator come from a Framingham study published in 2008, in which researchers recorded baseline information for 8,491 initially healthy men and women between 30 and 74. After 10 years, they documented which participants developed cardiovascular disease (including angina, coronary death, coronary insufficiency, heart attack, heart failure, hemorrhagic stroke, ischemic stroke, transient ischemic attack, or peripheral artery disease) and then looked at the risk factors they started with. Based on those findings, the researchers developed equations and tables that can estimate an individual's risk of developing cardiovascular disease over 10 years based on age, gender, systolic (upper) blood pressure level, total and HDL (good) cholesterol levels, and whether the person smokes, has diabetes, or takes blood pressure drugs. For people who don't know their cholesterol levels, the equations allow users to use their body mass index (which compares weight with height) instead.

What's your risk of having a heart attack or stroke?

Our calculator can estimate your risk of having a heart attack, stroke, or other cardiovascular event in the next 10 years, and help us develop recommendations for what you can do to keep your heart healthy.
Start Calculator

Our calculator provides three pieces of information:

1. An estimate of your 10-year risk of developing cardiovascular disease

A low risk doesn't guarantee protection against the disease but shows that your chance of developing it is lower than for some other people. And a high risk doesn't mean it is inevitable but should serve as a warning. Some risk factors, such as increasing age and gender (men are at higher risk than women) can't be changed. But people can often reduce their risk by, for example, losing excess weight, quitting smoking, or lowering their blood pressure or cholesterol levels. People who stop exercising, gain weight, or adopt other unhealthy habits can expect their risk to increase.

2. A comparison between your current risk and your optimal risk

That is, the risk for someone your age and gender who has an optimal blood pressure level (a systolic of 110 millimeters of mercury, or mmHg); optimal cholesterol levels (a total cholesterol of 160 milligrams per deciliter and an HDL of 60 mg/dL); and who doesn't smoke, have diabetes, or take medication for high blood pressure. The optimal risk provides a benchmark that you can compare yourself against.

3. Your heart age

This is the age of someone of your gender in normal health, who has the same 10-year risk as you do. This hypothetical "normal" person does not smoke or have diabetes, doesn't take medication for high blood pressure, and has a systolic blood pressure of 125 mmHg, a total cholesterol of 180 mg/dL, and an HDL of 45 mg/dL.