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Controversies in Internal Medicine
May 22, 2006

Atherosclerosis Imaging of Asymptomatic IndividualsIs the Sales Cart Before the Evidence Horse?

Arch Intern Med. 2006;166(10):1065-1068. doi:10.1001/archinte.166.10.1065

Although appealing, screening for subclinical vascular disease remains a controversial topic. In addition to exercise stress testing, which I will not discuss herein, atherosclerosis detection technologies are available as a potential means to refine risk prediction. Such procedures include computed tomography for coronary calcification, ultrasound for carotid intima media thickness, ankle-brachial index, and brachial artery reactivity. They are expensive, induce further expensive testing, and their use is burgeoning despite what I believe is insufficient evidence to support such practice. I present an argument that opposes the practice of screening for atherosclerosis in asymptomatic individuals at this time, consistent with the US Preventive Services Task Force review that there is insufficient evidence to support its routine use.1

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