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CAROTID ARTERY IMAGING: Measuring plaque
NatureMed Clinic Boulder/ Denver
Were you given a prescription for a medication to control cholesterol by your doctor but are not sure if you should take it? Do you question whether you even have plaque in your arteries? Non there is an easy way to see if you have plaque.
Carotid artery intima-media thickness (CIMT) measured by ultrasound has been shown to be correlated with the presence of cardiovascular disease and is now accepted and used as a marker for atherosclerotic disease. In the Cardiovascular Health Study, increases in the CIMT of the carotid artery were associated with an increased risk of heart attack and stroke in older adults without a history of cardiovascular disease. Common carotid IMT greater than 0.87 mm and Internal Carotid IMT greater than 0.90 mm were associated with a progressively increased risk of cardiovascular events. For each 0.20 mm increase in CCA IMT, the risk increased by almost 30%. IMTs above 1.18 mm were associated with more than a 2-fold increase in the risk of a cardiovascular event over 6 years.
Also, several studies evaluated the effect of statins on the progression of atherosclerosis using imaging of CIMT as an outcome measure. In these studies carotid IMT was used a surrogate marker for coronary atherosclerosis. The LIPID trial randomized 522 subjects to receive pravastatin 40 mg/day or placebo in addition to a low-fat diet. Total cholesterol, triglycerides, HDL, and LDL cholesterol were measured at randomization repeatedly during follow-up. Ultrasound scans of the common carotid artery were performed before randomization, and after 2 and 4 years using B-mode ultrasonography. The study showed a regression of the common carotid artery IMT following pravastatin therapy.
According to recent evidence from the ARBITER 6-HALTS trial, treatment with extended-release niacin, in combination with statin therapy, significantly increases HDL-cholesterol levels and causes a small, but significant, reduction in carotid intima-media thickness. Niacin alone also reduces CIMT.
Ten patients were supplemented with pomegranate for 1 year and five of them continued for up to 3 years. Blood samples were collected before treatment and during PJ consumption. In the control group that did not consume pomegranate, CIMT increased by 9% during 1 year, whereas, pomegranate consumption resulted in a significant IMT reduction, by up to 30%, after 1 year.
2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults
Imaging Guidelines for Screening CV Risk
Consensus Statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force
Society for Heart Attack Prevention and Eradication
Society of Atherosclerosis Imaging and Prevention
The ARIC Study - CIMT and Presence or Absence of Plaque Improves Prediction of CHD Risk
ARIC Risk Calculator
CAC and CIMT in the Multi-Ethnic Study of Atherosclerosis (MESA)
Asymptomatic Atherosclerosis Book
CardioHealth Station by Panasonic (carotid ultrasound)
Carotid IMT received a higherlevel of recommendation in the2010 ACCF/AHA Guidelines thanmany other widely used tests such as:
● Advanced Lipoprotein Analysis, including Lp(a)
● C-Reactive Protein
● Hemoglobin A1C
● Lipoprotein-associated phospholipase A2 (Lp-PLA2)
● Resting ECG (in those without HTN or DM)
● Resting Echocardiography
● Genotype Testing
● Exercise ECG
● Stress Echocardiography
I was very impressed by the detailed workup Dr. Steve did. It was obvious he was on the forefront regarding blood testing. After being told for years and my cholesterol is too high a case was never made for why I should take medication. Through my meetings with Dr. Steve he made me aware of the fact that I had every six independent risk factors for heart attack andnow I am being treated aggressively. EB Boulder, Colorado