Harvard Heart Letter

Be wary of commercial cardiovascular screening services

The tests they offer come without objective advice from a physician and may be worthless.

commercial cardiovascular screening services
For-profit companies often send offers for "potentially lifesaving" health screening tests through the mail.
Image: Steve Mason/Thinkstock

Screening tests for heart disease, stroke, and other diseases have a lot of intuitive appeal. Of course it is better to catch a disease in an earlier, more treatable stage and prevent a potentially fatal event. If only it were that simple.

Screening tests are never 100% accurate, so they can lead to false positives—results that suggest that a disease might be present, but follow-up tests show that it isn't. That additional testing may add cost and stress, and in some cases, cause harm. On the flip side are worrisome false negatives—when the tests fail to detect a disease that is present.

It is against this backdrop that private, for-profit companies are marketing tests directly to consumers to look for early signs of cardiovascular disease and other conditions. The testing is often performed in churches or community centers, although some companies have their own fleet of mobile screening vans. But experts say that anyone considering such testing should proceed with caution.

Out-of-context advice?

The lack of discussion and guidance from a physician is the main thing that concerns doctors about these stand-alone tests. "Screening is all about the context," notes Dr. J. Michael Gaziano, a chronic disease expert at Harvard-affiliated Brigham and Women's Hospital. A test that might be advisable for one person because of risk factors and health status won't be advisable for another with a different profile, says Dr. Gaziano. The interpretation of the results and the kind of follow-up needed will vary, too.

The screening companies advertise their services through the mail and on websites, where customers are typically offered a variety of different tests based on information about their age, sex, and health history. In Dr. Gaziano's view, the risk factor information the companies collect is "very crude." The price varies by the type and number of tests. One five-test package that included screening tests for carotid artery disease, peripheral artery disease, abdominal aortic aneurysms, atrial fibrillation, and osteoporosis was priced at $149 in the Boston area. However, if you meet certain criteria, some of those services may available to you at no out-of-pocket cost because they are covered by Medicare Part B and other insurers.

What the experts advise

But do the cardiovascular screening tests even make sense for most healthy people? For the most part, the answer is no, according to the U.S. Preventive Services Task Force (USPSTF), an advisory group of experts that draws up guidelines for physicians about such testing (see "Cardiovascular screening tests: Should you have them?").

The one exception is screening for an abdominal aortic aneurysm, a bulge in the vessel that carries blood away from the heart to the rest of the body. The bulge may enlarge slowly over time and burst with little warning, leading to dangerous—often fatal—bleeding. Older male smokers face the highest risk, which is why men ages 65 to 75 who have ever smoked should undergo a one-time ultrasound test to check for this condition. (Smoking at least 100 cigarettes during your lifetime qualifies you as an "ever" smoker.)

But the USPSTF discourages screening for carotid artery stenosis, which occurs when fatty deposits build up and narrow the arteries that run up either side of the neck and supply blood to the brain. Dr. Gaziano agrees: "I don't use it as a screening test at all." Not only is this condition very rare, occurring in only about 0.5% to 1% of the population, the ultrasound screening tests produces a high number of false positive results. That triggers a cascade of follow-up invasive tests and other procedures that can cause serious harm, including a heart attack or stroke.

Empowered patients

Many doctors want their patients to be more involved in their health care. Dr. Gaziano doesn't want his reservations about commercial screening tests to suggest a return to the days of passive patients and the "doctor knows best" attitude. He's all in favor of do-it-yourself efforts like home blood pressure monitors and heart attack risk calculators, like this one: www.health.harvard.edu/heartrisk .

Commercial screening businesses give people choices about what kind of screening tests they want to get. But for many, that might be more confusing than empowering. In specific circumstances, some of these tests are clearly useful. But you really need a physician who knows your medical history to provide that much-needed perspective, says Dr. Gaziano.

Cardiovascular screening tests: Should you have them?

The U.S. Preventive Services Task Force (USPSTF) issues recommendations based on research. Here are USPSTF recommendations for several popular cardiovascular risk tests.

Health condition



Abdominal aortic aneurysm (bulge in the aorta below the heart)

Abdominal aortic ultrasound

One-time screening in men ages 65 to 75 years who have ever smoked. Men 65 to 75 who never smoked could still consider it after an assessment of risk factors by a physician.

Carotid artery stenosis (clogged neck arteries)

Carotid ultrasound

The routine use of carotid ultrasound screening is not recommended in otherwise healthy individuals.

Peripheral artery disease (clogged leg arteries)

Ankle-brachial index

Insufficient evidence to make a recommendation for or against screening for peripheral artery disease in people without symptoms.