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To the Editor: Dr O'Malley and colleagues¹ found that receipt of a screening "heart scan" provided neither benefit nor harm to a young, predominantly male military population at low 10-year risk of incident coronary heart disease (CHD).

Nevertheless, I remain concerned about the potential harms of computed tomography (CT) screening for CHD among older populations, particularly when undertaken outside of the context of research protocols. A visual diagnosis of silent CHD could have adverse mental health consequences in older patients who seek testing to allay fears of myocardial infarction and sudden death.

Moreover, outside of research protocols, follow-up evaluation of older individuals will frequently devolve to physicians with little experience interpreting calcium scores. Unaware of the high prevalence of coronary calcium in older populations,² many physicians may refer older patients with detectable coronary calcium for stress testing, which would likely have a low positive predictive value in asymptomatic patients.³ When . . . [Full Text of this Article]

Joshua J. Fenton, MD
Robert Wood Johnson Clinical Scholars Program
Department of Family Medicine
University of Washington
Seattle

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