Cardiovascular and Lipid Disorder Screening

Refugees should be screened for cardiovascular and lipid disorders in accordance with the US Preventive Services Task Force (USPSTF) guidelines (Table 3). 18 Although blood pressure and nonfasting serum lipid testing can be performed at the new-arrival medical screening examination, other screening tests recommended by the USPSTF may not be conducted at this visit but should be done in a reasonable time frame after arrival. Adults found to have hyperlipidemia or hypertension should be formally screened for diabetes with a fasting blood glucose measurement, in accordance with USPSTF guidelines, and should be referred for long-term management.

Table 3. U.S. Preventive Services Task Force Guidelines for routine medical screening for lipid disorders, hypertension, and abdominal aortic aneurysm.

Lipid disorders Screen and treat men ≥35 years and women ≥45 years of age for lipid disorders by obtaining, at the minimum, total cholesterol and high-density lipoprotein levels. These can be checked in a nonfasting state.

Screen and treat men 20-35 years and women 20-45 years of age if they have increased risk for coronary heart disease (diabetes, tobacco use, hypertension, family history of cardiovascular disease before age 50 in male relatives or age 60 in female relatives, or a family history suggestive of familial hyperlipidemia)

Hypertension Screen men and women ≥18 yearsg
Abdominal aortic aneurysm Screen by ultrasonography men aged 65-75 years of age if they have ever smoked
  • Adapted from USPSTF18
  • gAll refugees should have an initial blood pressure checked at the new-arrival medical evaluation.

Through acculturation, refugees may adopt diets and lifestyles that increase their risks of obesity, diabetes, and cardiovascular diseases. Because of competing concerns of settling in a new country, the new-arrival screening visit is not the ideal setting to discuss regular exercise and healthy diets, but the importance of yearly preventive visits should be discussed, and people with disease may be identified. Given clinical latitude, for refugees who are especially well adjusted it is appropriate to discuss likely future issues such as obesity, diet, and exercise. Translated and culturally sensitive education materials should be distributed when available.

References

  1. U.S. Preventive Services Task Force. Recommendations. Available at: http://www.ahrq.gov/clinic/pocketgd.htmExternal External Web Site Icon. Accessed 7/2, 2012.