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The Big Question
If you could have a test performed that could predict the likelihood of having an adverse cardiovascular event, like a heart attack or stroke, would you be interested? I want to introduce an inexpensive, non-invasive, fast and simple test that can do just that.
The Current Model
Treating and preventing cardiovascular disease is a focus for many health care providers. Medical guidelines are established to aid health care providers in making evidence-based decisions about things such as when lifestyle interventions are appropriate, when to use particular medications, and when to escalate treatment. Web-based tools, and risk prediction calculators, are used to stratify a patient’s risk and to place them in to different categories for treatment. Some of these tools can reliably predict when an individual has an increased risk; however, they often underestimate risk in an alarming majority of individuals (86% according to the scientific research )who go on to experience an adverse cardiovascular event, like a heart attack or stroke. But, the guidelines, and risk predictors, leave out one of the most predictive tests.
There is a simple ultrasound test that can be performed, which research has demonstrated to predict 98.6% of future adverse events, which is better odds than an at-home pregnancy test. The test is called a carotid intima-media thickness (IMT) test. The tunica intima and tunica media are two different layers inside of the blood vessel. The carotid IMT test uses a rigorous protocol for measuring the general thickness of the arteries and to look for atherosclerosis, or plaque, inside the arterial wall. The average thickness of the artery, the variability of thickness in measurements, and the presence and characteristic of plaque are all useful for predicting one’s risk.
Mixed plaque identified in a 48-year-old, otherwise healthy, male with 'normal' cholesterol.
Clarity on the Issue
There is another common ultrasound scan of the carotid arteries that is often confused with the carotid IMT test, it’s called a carotid duplex scan. This scan is often sold at discounted rates as part of a health screening package and unfortunately does not provide the same information. The carotid duplex scan is a simple measure of blood flow through the arteries of the neck. A duplex scan does not assess the lining of the artery wall for thickening and duplex scan reports are often noted ‘Normal’ with up to a 50% blockage in the carotid arteries. In fact, they are so unreliable, that the United States Preventative Services Task Force (USPSTF) has advised against this test for screening for vascular disease in asymptomatic healthy adults.
The carotid IMT Test is not often covered by insurance which leaves most consumers to pay cash for the test and the price can range from $250-$450 depending on who performs the exam and how it is graded. It is a great tool for diagnosing risk, monitoring improvement to treatment, and deciding when not to use a medication when other traditional risk factors might dictate otherwise, according to medical guidelines. Carotid IMT is one of the most useful tools in cardiovascular disease diagnostics. To read more about the details of the IMT Test, click HERE.
