USPSTF recommends against screening asymptomatic adults for carotid artery stenosis

The U.S. Preventive Services Task Force reaffirmed its 2014 recommendation for carotid artery stenosis screening in asymptomatic adults, saying the risks outweigh the benefits. It is listed as a D recommendation.

The decision was based on an analysis of 2,373 titles and abstracts and 144 full-text articles on asymptomatic carotid artery stenosis (CAS) screening that were published after the 2014 recommendation was made. However, “no eligible studies were identified that directly examined the benefits or harms” of it, Janelle M. Guirguis-Blake, MD, a physician in the family medicine and obstetrics department at MultiCare Tacoma Family Medicine in Tacoma, Wash., and colleagues wrote in JAMA.

The USPSTF wrote in its recommendation statement that the prevalence of asymptomatic CAS is “low in the general population but increases with age.” The task force also noted it has issued other relevant recommendation statements on stroke prevention and cardiovascular health, including B recommendations regarding behavioral counseling, screening for abdominal aortic aneurysm and statin use.

The recommendation for asymptomatic CAS screening puts prevention primarily in hands of patients, according to Aaron B. Caughey, MD, MPP, MPH, PhD, USPSTF task force member and associate dean for Women’s Health Research and Policy at Oregon Health & Science University.

“Screening for CAS does not prevent strokes, but healthy lifestyle choices can,” he said in a press release. “People can reduce their risk of cardiovascular disease, including strokes, by controlling high blood pressure and cholesterol, maintaining a healthy weight, being physically active, eating a healthy diet and not smoking.”

In a related editorial, Larry B. Goldstein, MD, co-director of the Kentucky Neuroscience Institute and chair of the neurology department at the University of Kentucky, wrote that currently available data “clearly support the reaffirmed USPSTF recommendation” for asymptomatic CAS screening. However, that could change in the future as newer technologies become more frequently studied.

“There are no available data from randomized trials comparing CAS with [trans–carotid artery revascularization],” he wrote. “Additional studies will be required to determine the role of this evolving technology and may present an additional consideration for future guidelines regarding the utility of population screening for carotid disease.”

References:

• Goldstein LB. JAMA. 2021;doi:10.1001/jama.2020.26440.
• USPSTF. JAMA. 2021;doi:10.1001/jama.2020.26988.