Family Medicine Update

Diamond GA, Kaul S. Am J Cardiol. 2007 Apr 1;99(7):1013-5. Epub 2007 Feb 15.

It has been proposed recently that asymptomatic adults undergo routine screening
for subclinical atherosclerosis using electron-beam computed tomography or
carotid ultrasound as the basis for the pharmacologic prevention of
cardiovascular events. The expected cost and effectiveness of this conditional
test-treatment strategy are herein analyzed in comparison with the conventional
conditional strategy, based on Framingham risk factor assessment, and with an
unconditional treatment strategy that does not rely on testing. These analyses
show that the unconditional treatment strategy, albeit more costly, is more
effective and more cost-effective than either conditional testing strategy. In
conclusion, greater attention should be paid to improving the population-wide
delivery of and long-term adherence to proven preventive therapy than to the
identification of “high-risk” treatment targets.  more…