Accuracy of Screening Tests

Several screening mechanisms exist for CHD: electrocardiogram (ECG), exercise testing, and electron beam computed tomography (EBCT) for coronary calcium. The sensitivity of resting ECG abnormalities for CHD is low. The sensitivity of an exercise test ranges from 10% to 70% and the predictive value from 2.2% to 24%. False-positive results are more likely for young persons and women (Pignone et al., 2003). Evidence is limited on the use of nontraditional risk factors in CHD assessment, including ankle-brachial index (ABI), leukocyte count, fasting glucose level, periodontal disease, carotid intimal medial thickening, EBCT, homocysteine level, lipoprotein(a) level, and high-sensitivity C-reactive protein (hs-CRP) level. Screening for cerebrovascular disease with an ultrasound of the carotid artery to detect significant stenosis has a reported sensitivity of 86% to 90% and specificity of 87% to 94% (Wolff, 2007).

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