Who to test · screening criteria
Selection criteria
Assess any patient who meets one criterion: age over 50 with a cardiovascular risk factor, age over 70, hypertension, overweight or raised abdominal girth, current or former tobacco use, or diabetes or impaired glucose tolerance. Then match the assessments to the presenting question rather than running everything.
Two questions, answered separately: which patients should be assessed, and which assessments should each of them have.
Which patients should have cardiometabolic testing?
The population criteria are deliberately broad, because the yield in this population is high and the assessments are non-invasive.
| Criterion | Rationale |
|---|---|
| Age over 50 with a cardiovascular risk factor | Vascular and small-fiber change is prevalent and silent in this group |
| Age over 70, unconditionally | Vestibular dysfunction and peripheral artery disease prevalence both rise steeply with age |
| Hypertension | Small-vessel damage and impaired autonomic blood pressure control coexist |
| Overweight or raised abdominal girth | Metabolic health prevalence falls sharply with adiposity |
| Current or former tobacco use | The strongest single association with peripheral artery disease |
| Diabetes or impaired glucose tolerance | Small-fiber injury begins during the compensating phase |
Which tests match which symptoms?
Match the panel to the presenting question rather than running everything.
Numb, burning or insensate feet
Sudomotor testing, vascular study with toe-brachial index, laboratory panel including glycemic and B12 markers. Sudomotor testing
Claudication or reduced walking distance
Ankle-brachial and toe-brachial index, pulse volume recording, arterial stiffness. Ankle-brachial index
Unsteadiness, dizziness or a fall
Vestibular and oculomotor battery, orthostatic and autonomic testing, sensory assessment, cognitive screen. Balance testing
Fatigue, exercise intolerance, palpitations
Heart rate variability, cardiac autonomic reflex tests, pulse waveform analysis. Heart rate variability
Weight that will not move, or a stalled program
Measured resting energy expenditure and respiratory quotient, body composition, insulin and glycemic markers. Indirect calorimetry
Asymptomatic, in the risk group
The core panel: vascular study, sudomotor, autonomic, body composition, laboratory. The full library
Who should not be tested?
- Anyone in an acute presentation. Chest pain, acute limb ischemia, sudden neurological deficit or acute infection needs emergency care, not a diagnostic appointment.
- Low-risk asymptomatic adults under 50. The yield does not justify it.
- Patients for whom the result cannot change management — because of comorbidity, prognosis or preference.
- Patients with implanted electrical devices, for the bioimpedance component specifically. The remainder of the suite proceeds.
How often should testing be repeated?
Set the interval from the finding, not from the calendar. A normal study in a risk-group patient usually repeats annually. A borderline finding repeats sooner, under controlled conditions, before anything is concluded from it. An abnormal finding under active management repeats at whatever interval makes the intervention assessable — often three to six months for metabolic measures, longer for structural vascular ones.
For patients: the same subject written for the person having the assessment is at who should be tested.
Talk to someone about testing
Tell us what you are trying to find out and we will explain which Measura assessments answer that question, what each one involves, and how the results are reviewed with a clinician.
4477 Woodson Rd, Suite 201, St. Louis, MO 63134. Monday to Friday, 9:00 a.m. to 5:00 p.m. Please do not send symptoms, diagnoses or images through a web form — a website form is not a secure medical channel. Send your name and number and we will call you back.
Common questions
Should asymptomatic patients be assessed at all?
In the defined risk group, yes — that is where the silent findings are. Who should have this testing.
How do I choose between sudomotor testing and a nerve conduction study?
They measure different fiber populations; the presenting symptom usually tells you which. Small-fiber versus large-fiber neuropathy.
What repeat interval should I use?
Set it from the finding and from what is being changed. Repeat intervals.
Which tests are used for numb or burning feet?
Numb, burning or insensate feet call for sudomotor testing, a vascular study with toe-brachial index, and a laboratory panel that includes glycemic and B12 markers. The panel is matched to the presenting question rather than running every test. Unsteadiness, claudication, fatigue and a stalled weight program each call for a different set of assessments.
Can patients with an implanted electrical device be tested?
Yes, with one exception. Patients with implanted electrical devices skip the bioimpedance component only. The remainder of the suite proceeds as normal, so the vascular, sudomotor, autonomic, balance and cognitive assessments are still available to them, and the panel is still matched to the question the patient presents with.
Should patients with acute symptoms be tested?
No. Anyone in an acute presentation needs emergency care, not a diagnostic appointment. That includes chest pain, acute limb ischemia, a sudden neurological deficit or an acute infection. The assessments are for the risk-group patient who is stable, where a finding can still change management.
Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP, medical director of Measura. Last reviewed .