University of Maryland Vascular Surgeon Coordinates National Study
A University of Maryland vascular surgeon says he is surprised by the higher-than-expected percentage of people with vascular disease discovered during the first-ever free national screenings held at 17 sites throughout the U.S. in May. Thirteen percent of participants in the screenings had signs of potentially lethal or disabling vascular conditions: blocked carotid arteries, aortic aneurysms and peripheral arterial disease. The majority of participants told screeners they did not have diabetes or elevated cholesterol levels, and they did not smoke-all factors that may contribute to vascular disease.
"In a typical screening program aimed at the general public, you would expect abnormal findings in 5-to-10 percent of those tested," says William R. Flinn, M.D., head of vascular surgery at the University of Maryland Medical Center and professor of surgery at the University of Maryland School of Medicine. "By our usual standards, the people in this group were healthy. But the fact that 13 percent had abnormal numbers underscores the magnitude of undiagnosed vascular disease in the U.S."
Dr. Flinn coordinated the screening program for the American Vascular Association (AVA). He says the program had several purposes: to detect disease, to raise public awareness of vascular disease and its easy diagnosis, to test the feasibility of a nationwide screening effort, to develop statistics on the prevalence of undiagnosed vascular disease, to prove the value of simplified vascular screening procedures and to refine the program to screen thousands of people in the future.
"Everybody knows about heart disease, and the importance of detection and treatment," says Dr. Flinn, "but almost no one knows about vascular disease beyond the heart."
An estimated 20 to 30 million people are at risk for stroke, peripheral arterial disease (PAD), carotid artery disease and aortic aneurysms. Stroke is the third leading cause of death in the United States. Ruptured abdominal aortic aneurysm is the tenth leading cause of death in men over age 60 in this country.
The screening program tested 859 people with a mean age of 68. Sixty-one percent were women. The racial composition of those screened included 81 percent white, eight percent African-American, six percent Hispanic and three percent Asian.
Each screening center followed a uniform protocol that included three noninvasive ultrasound tests to detect vascular conditions. These tests were shorter, basic versions of the more complex scans typically performed to confirm vascular disease among patients with a preliminary diagnosis. Each scan measured key indicators that signal vascular disease. The ten-minute screening sessions also included a blood pressure check and an EKG screen for atrial fibrillation (AF)-abnormal electrical impulses that disrupt the normal pumping action of the heart. AF can cause the formation of blood clots, and raise the risk of stroke.
Participants with abnormal readings were given appointments for a more complete ultrasound study, also offered at no charge. Abnormal results indicating possible vascular disease occurred more often in older people. The mean age for those with abnormal results was 73.
Mild-to-moderate carotid artery blockage occurred in 53 people, or 6.2 percent of the total participants screened. The carotid arteries are located in the neck and supply blood to the brain. Blockages can cause paralyzing strokes. This group did not need surgery, but doctors recommended preventive steps such as medication to halt further blockage, along with regular monitoring. However, surgery was recommended in a smaller group of 14 people, or about two percent of those screened, who had carotid blockages of 80-to-99 percent.
Abdominal aortic aneurysms were detected in 15 people, again about two percent of those tested, with sizes ranging from three to seven centimeters. Surgery is recommended if the aneurysm is five centimeters (about the size of a lime) or larger. An aneurysm is the ballooning or dilation of the wall of the aorta, the main artery of the chest and abdomen. The aorta carries blood flow from the heart to all the vital organs and eventually to the legs and feet. Abdominal aortic aneurysms are caused by a progressive weakening of the aortic wall and will grow larger and eventually rupture if the aneurysm is not diagnosed and treated.
Sixty-two people, or seven percent of the total, showed signs of peripheral arterial disease. PAD is a painful condition that impairs circulation to the legs and can lead to serious disability or even amputation. It can also be a sign of widespread hardening of the arteries.
The symptoms of most vascular conditions are not obvious until the disease reaches an advanced stage. "The first symptom may be a crisis," says Dr. Flinn. "While we do our best to treat people with ruptured aneurysms, 50-to-75 percent of them die even with emergency surgery. We would prefer to see them before the rupture, when there's a chance to prevent damage and even achieve a cure."
According to Dr. Flinn, the American Vascular Association hopes the quick screening will eventually become as commonplace as a check for cholesterol or high blood pressure. He says the success of this year's program proves national screening can be done, and the number of abnormal findings shows the importance of screening to catch vascular problems in time for preventive treatment. Next year, the AVA plans to screen upwards of 10,000 people at 100 sites. The goal for the following year is 100,000 screenings.
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