Screening for heart disease: Which tests are worth your money?

February is heart month, and with it come public health messages aimed at getting you to take a closer look at your risk of developing heart disease. There are multiple tests you might see marketed, but they are not all especially useful.

Tests for cholesterol and sugar levels in your blood are among the less expensive, but you can spend a significant amount of money on complex ultrasound evaluation for blockages of the carotid artery, and special CAT scans to help predict cardiac risk. No price may seem too high to pay if you can prevent a heart attack, but unfortunately, not all cardiac conditions can be found ahead of time.

Fortunately, these tests have been studied a great deal. The U.S. Preventive Services Task Force compiles the scientific evidence in order to make recommendations; you can see its many findings at uspreventiveservicestaskforce.org.

Let’s take a look at each of these tests and find out whether they really help.

1. Blood tests, including cholesterol and blood sugar. It is a good idea to get screened for high cholesterol and diabetes with a blood test every year or two. This can be done by seeing your doctor, who will order these tests, which are covered by insurance. You may even see opportunities to get these tests for free in February at some pharmacies and clinics. One note of caution: Just getting a total cholesterol number without its components, which include triglycerides, good cholesterol (HDL), and bad cholesterol (LDL) won’t provide enough information for your doctor.

2. Screening heart scans. There are companies that will come to churches and synagogues and scan your body with an ultrasound to look for carotid blockages, abdominal aneurysms, and other vascular problems. These tests are often advertised for $149. They are not covered by insurance, so this is an out-of-pocket expense. I sometimes joke that they are not heart scans, but heart scams. Why? All of these tests can be ordered by your doctor, and then would be covered by insurance.

Because cigarette smokers have a higher risk of developing an abdominal aneurysm, it is recommended that any man over age 65 who has smoked get a onetime screening ultrasound of the abdomen; the recommendation is not so clear for women. Insurance will cover it if ordered by your doctor.

3. Screening EKGs. A 12-lead electrocardiogram is a basic test that looks for an irregular heartbeat or silent heart attack if symptoms suggest there may be an issue, but it has not been shown to be especially helpful to screen for problems in asymptomatic people. Unless you have multiple risk factors for coronary artery disease (family history, high blood pressure, cholesterol, smoking, obesity), or need an EKG before an upcoming surgery, it has minimal utility. Many student athletes are screened with an EKG before participating in sports. Studies have shown this to be helpful, as it can pick up congenital abnormalities. But the downside is finding issues that will require more tests, potentially sidelining healthy young athletes.

4. A screening stress test. If you have no chest discomfort, shortness of breath, or other worrisome symptoms, a stress test will not add much useful information. Although very safe, the downside is that a false positive result may lead to more invasive testing, such as a cardiac catheterization, which could possibly lead to an unnecessary stent or bypass surgery.

5. A calcium scoring CAT scan. If you have multiple cardiac risk factors, especially a strong family history of coronary artery disease, this simple test may be an attractive option. It is a low-radiation scan — about the same as in a mammogram — that takes a “snapshot” of the coronary arteries to see whether there is calcium present. The absence of any calcium implies a low cardiac risk for the next 10 years. A high calcium score suggests a much higher risk. The downside: It is not covered by insurance, with an out-of-pocket expense of less than $110 at most facilities.

The bottom line: Save your money and do not rush to get expensive scans of dubious worth. It is a good idea to get your cholesterol and sugar screened, but this should be covered by insurance if your doctor orders it. If you are going to pick a test to spend your hard-earned money, talk to your doctor about a calcium scoring CAT scan.

David Becker, M.D., is a frequent Inquirer contributor and a board-certified cardiologist with Chestnut Hill Temple Cardiology in Flourtown, Pa. He has been in practice for more than 25 years.