Heart scans tied to ‘evidence-free’ cure

Updated On: Tuesday, May 24, 2011

NEW YORK: When symptom-free people have heart scans to look for clogged arteries, they can end up with overtreatment and side effects, researchers said Monday.

In a study published in the Archives of Internal Medicine, they found people who had the scans were much more likely to be put on medications and undergo surgery than those who chose standard health screening.

The scans, called coronary computed tomography angiography or CCTA, produce a detailed image of the heart that reveals cholesterol buildups in the coronary arteries.

If they get big enough, such buildups may cut the blood flow and cause a heart attack. So in theory, treating them early on might help stave off some the more than 1.2 million heart attacks -- a third of them fatal -- that occur every year in the U.S.

Yet there's no evidence that treating people based on heart scan results does any good, said Dr. John McEvoy, of Johns Hopkins Ciccarone Center for the Prevention of Heart Disease in Baltimore, who led the new study.

By contrast, it's well known that the scans expose patients to a high dose of X-rays, which can increase their likelihood of developing cancer. And the dyes used to enhance the images cause kidney damage in a significant portion of people.

"Testing might lead to more harm than good," McEvoy said, adding that heart scans may cost $600 or more.

His team looked at 1,000 Korean patients who chose to get a heart scan as part of a health screening program at Seoul National University Bundang Hospital.

The researchers compared those patients to closely matched individuals who opted to forgo the scans -- not currently recommended by guidelines -- and just get the standard health checkup.

More than a fifth of the patients who got scanned had cholesterol buildups in their arteries, also called atherosclerosis.

Three months later, these individuals were using cholesterol-lowering statins 34 percent of the time and blood-thinning aspirin 40 percent of the time. In those who tested negative for atherosclerosis or didn't get scanned, less than 10 percent used the medications.

People who got scans also had more additional tests and major heart procedures.

The researchers expected that if the extra drugs and procedures were actually helpful, the treated people would have a lower rate of serious heart problems in the future.

But after another 18 months, there was no such difference. There was just one event in the 1,000 people who had CCTA (one case of hospitalization for chest pain) and one in the 1,000 people who didn't (a heart-related death).

Currently, whether a patient gets statin or aspirin is based on risk factors such as their age, and how much cholesterol is in their blood. Both drugs have side effects, notably joint problems and bleeding ulcers.

Although the study can't prove that getting a scan caused the extra medication use, the gap could not be explained by differences in risk factors for heart disease, such as cholesterol levels or smoking.

In an editorial, Dr. Michael S. Lauer of National Heart, Lung, and Blood Institute in Bethesda, Maryland, said the new study serves as a reminder of the downsides of screening.

"Physicians cannot easily ignore diagnoses made with screening tests because it is impossible for them to determine whether their patients have real disease or pseudodisease," Lauer notes. "Therefore, physicians prescribe tests, medications, procedures, or even surgical procedures, all of which carry inherent risks."

McEvoy agrees. "With these new imaging techniques, we are left with the dilemma of what to do with the results," he said.

Even when screening helps predict health problems down the road, Lauer adds, that doesn't mean treatments are necessarily beneficial.

"Overdiagnosis is threatening to become an increasingly important public health problem because of the enthusiasm for and proliferation of unproven screening tests," Lauer writes.

McEvoy said there have been several reports of doctors doing CCTA heart scans in healthy patients, although the practice is currently discouraged by the American Heart Association.

According to McEvoy, doctors should focus on patients' lifestyle and traditional risk factors such as smoking and obesity. (Reuters)

Times Square suspect says he acted alone: official

Updated on : Tuesday, May 04, 2010

NEW YORK: A law enforcement official says the man accused of driving a bomb-laden vehicle into Times Square was arrested onboard a flight set to leave a New York airport for Dubai.

The official familiar with the investigation tells a foreign news agency that Faisal Shahzad was taken into custody aboard the flight at Kennedy International Airport.

The official spoke on condition of anonymity because of the sensitivity of the investigation.

The official says investigators still don't have evidence that Shahzad is connected to the Pakistani Taliban or any foreign terror groups.

The official says, “He's claimed to have acted alone, but these are things that have to be investigated."

Times Square cleared as suspected car bomb found

Updated on : Sunday, May 02, 2010

NEW YORK: Police found a suspected car bomb in a smoking sport utility vehicle Saturday evening in Times Square, then cleared the streets of thousands of tourists milling through the landmark district so they could dismantle the device.

A white robotic police arm broke windows of the black Nissan Pathfinder to remove any explosive materials while heavily armed police and emergency vehicles shut down the city's busiest streets, teeming with taxis and theatergoers on one of the first summer-like days of the year.

Investigators removed bomb-making materials, including propane tanks, explosive powders and a crude timing device, top police spokesman Paul Browne said.

"There were explosive elements, including powder, gasoline, propane and some kind of electrical wires attached to a clock," Browne said early Sunday. "No motive has been identified."

An officer noticed smoke coming from the SUV around 6:30 p.m. and cleared the streets. The area remained closed more than seven hours later.

Police are investigating a report that someone was seen running from the vehicle at some point and are reviewing security videotapes, Browne said. The Nissan Pathfinder's license plates do not match the car's registration, he said.

Police evacuated several residential and commercial buildings and cleared the streets of people. Police were deployed around the area with heavy weapons on empty streets in the heart of busy midtown Manhattan.

Some tourists reported hearing a small explosion hours after the car was first located.

Shelly Carlisle, of Portland, Ore., said police crowded into her Broadway theater after the curtain closed on "Next to Normal," a show on the same block where the SUV was found.

"At the end of the show, the police came in. We were told we had to leave," Carlisle said. "They said there was a bomb scare."

The car was parked on 45th Street, and the block was closed between Seventh and Eighth avenues as a precaution, police said. Times Square lies about four traffic-choked miles north of where terrorists bombed the World Trade Center in 1993, then laid waste to it on Sept. 11, 2001.

FBI agents are on the scene with the New York Police Department, and the matter is being taken seriously, said Paul Bresson, head of the FBI's public affairs office at bureau headquarters in Washington.

The Homeland Security Department is aware of the situation, but the NYPD has it under control and is investigating, said a Homeland Security official who spoke on condition of anonymity because the investigation is in progress.

The block that was closed is one of the prime blocks for Broadway shows, with seven theaters housing such big shows as "Billy Elliot" and "Lend Me a Tenor."

The curtain at "God of Carnage" and "Red" opened a half-hour later than usual, but the shows were not canceled, said spokesman Adrian Bryan-Brown.

Katy Neubauer, 46, and Becca Saunders, 39, of Milwaukee, were shopping for souvenirs two blocks south of the SUV when they saw panicked crowds.

"It was a mass of people running away from the scene," Neubauer said.

Said Saunders: "There were too many people, too many cops. I've never seen anything like it."

Mayor Michael Bloomberg left early from the White House correspondent's dinner Saturday night. A news conference was planned in New York for early Sunday.

President Barack Obama, who attended the annual gala, praised the quick response by the New York Police Department, White House spokesman Nick Shapiro said. He has also directed his homeland security and counterterrorism adviser, John Brennan, to advise New York officials that the federal government is prepared to provide support.

Brennan and others will keep Obama up to date on the investigation, Shapiro said.

In December, a van without license plates parked in Times Square led police to block off part of the area for about two hours. A police robot examined the vehicle, and clothes, racks and scarves were found inside.