Good morning friends and family! I hope you are doing well. I am helping Samantha do today's post because it is her first day working in the hospital! Wish her some luck in the comments down below.
I wanted to spend this morning reviewing some of the current cardiovascular screening guidelines recommended by The United States Preventive Services Task Force (USPSTF). For context, the USPSTF is a panel of experts in primary care that routinely review the most up to date published research and makes a series of unbiased recommendations to help prevent diseases from forming in our populations. These guidelines are updated and tweaked as new information gets released and it is something we spend a lot of time learning about in medical school and through residency, regardless of what specialty you go into.
Here are some of the most important recommendations they make with regards to cardiovascular health -
Hypertension Screening
Currently, it is recommended that adults >18 years old get screened for high blood pressure in TWO settings - once in the office during your appointment and one "outside" the clinical setting, such as at home or in the pharmacy before starting treatment.
This is to help avoid over-treatment from a phenomenon known as "White Coat Syndrome" where people's blood pressure may temporarily rise at the doctor's office out of fear or nerves.
The frequency of screening may vary from provider to provider or patient's risk factors but tends to be every 3-5 years becoming more frequent as one gets older.
https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/hypertension-in-adults-screening
Statin Initiation / Cardiovascular Disease Prevention
Statins are one of the most well-researched drug in the world and have been shown to be the most effective therapy for lowering LDL cholesterol and burden of atherosclerotic disease, such as heart attacks and strokes.
Deciding if and when to start patients on statins is a topic of great debate and requires a delicate balancing of their benefits (reduced mortality, lower risk of stroke and heart attack) with their drawbacks (cost of additional medication, occasional muscle cramps).
Currently, USPSTF recommends that in adults aged 40-75 years old who have 1 or more cardiovascular disease risk factor (high BP, diabetes, dyslipidemia, etc) and an estimated 10-year Atherosclerotic Cardiovascular Disease (ASCVD) risk >10% start a statin.
ASCVD risk can be calculated using calculators such as this - https://www.mdcalc.com/calc/3398/ascvd-atherosclerotic-cardiovascular-disease-2013-risk-calculator-aha-acc
Abdominal Aortic Aneurysm Screening
Here at Aortic Hope, we always remember to #ThinkAorta #ThinkFamily. Luckily, the USPSTF also shares this mantra.
It is well established that two of the greatest risk factors for abdominal aortic aneurysms (AAA) are male gender and smoking history.
Current guidelines from the group reflect this and recommend that all adult males aged 65-75 years old who have ever smoked undergo screening for AAA with ultrasound even if they have no family history.
Please be mindful that these guidelines are RECOMMENDATIONS and that screening may vary greatly based on your risk factors, your family history and your provider's input. For example, even though USPSTF only recommends AAA screening in male smokers, providers may want to screen female patients with extensive smoking history as well or a family history of aneurysm.
Alternatively, if you are under the age of 40 and have a family history of early heart attacks or have a very elevated LDL cholesterol (>190), your doctor may want to start you on a statin early. Nothing substitutes clinical shared decision making so be sure to have open conversations with your doctors and find the plan that works best for you!
And that's it for this post. I hope you guys have an amazing start to your week. Be sure to tune in to tomorrow's Topic Tuesday post as well with Duc! Until then, stay healthy and #ThinkAorta!
Adham
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