Got a lot of people that trying to figure out how to interpret their
results. Again, David Meinz has been going around the country doing these seminars
for years. There's a problem because most docs don't know how to interpret these.
The good thing is often very much related to the bad thing. We've got a lot
of people that are getting CIMTs and beginning to get awakened to risk that
they have for heart attack and stroke and risk that they can actually impact
to prevent that risk and prevent that event. So that's the good thing. The bad
thing is we've got a lot of people that trying to figure out how to interpret
their results. Again, David Meinz has been going around the country doing these
seminars for years. There's a problem because most docs don't know how to
interpret these. These patients get these, and then they don't know what to do with
it. They take it to their doc, and their doc says I don't know anything about
that. And it can't be any good. Here's what we're doing. This next video coming
now is gonna be about a little bit more detail on how to interpret these things.
As you know, we've done several hours. We've got oh maybe about a dozen videos
on CIMT. Now, this is one of them where Todd actually went through a lot of the
science with me and some discussions that he's had with the US Preventive
Services Task Force and why it's taken the medical advisory committees the
Standards Committee so long to begin to understand the science and warm-up to
CIMT. But let's get very practical, and that's what we're gonna do here. Speaking
of getting practical, you know we've got the webinar series. We've been doing
webinar series on insulin resistance, prediabetes, cardiovascular inflammation
where people actually can get their own results and then start tuning in with
groups with us and learning how to interpret these things. So those have
been very very well received, and we're starting those now with CIMT as well.
That's what the rest of this video is. I'm going to give you some examples. Some
of the examples are other people, the examples that have the name on them are
mine. When you get a CardioRisk CIMT, this is basically that will
look like. There will be four sections. This top section is thin, and it shows
you basically your arterial age. The bottom section is how they
calculated that arterial age, and we'll go into some depth on that in a few
minutes. Then you've got the middle section, and that can be kind of scary
because if you've got plaque at all, you're gonna often end up something in
red here. And again I have to spend a lot of time with a lot of patients saying,
whoa, wait a minute, it's not that bad a news.
Let's just back off and understand it But it also helps us understand the
science behind it. Usually, I start with talking about these three images, but
again I'm getting ahead of myself. The last thing that we talk about is the
actual plaque and whether or not you have discreet plaques, whether or not you
have calcified or soft plaque. And as you remember, this is the only screening
method that actually shows soft plaque. If you may remember, it goes back about 5...
6 years ago when I got my own first CIMT. I'm 62 now. I was like 56... 57. So was
about 5 or 6 years ago and I expected to do a victory lap after mine
in fact, though I had 73-year-old arteries. Now, that wasn't a happy moment.
So I've been through some of this pain myself in terms of that activity and
that discovery. And at the end of the day, we get to the punchline, and I had some
insulin resistance getting started that I had not been keeping an eye on because
I started doing more of this. At that time, I had access to a lot of CIMTs. And
over the next couple of years, as you could see here, the CIMT tech would come
in to do CIMTs for my patients. I'd get another one in within just a few
months after making some changes. One of them being I bit the bullet and agreed
to start taking a statin. But I made some other tweaks as well. Major one being
focusing on insulin resistance. Within a couple of years, I had a steady decline
from a 73-year-old arteries at age 57 to what 52-year-old arteries at
age 59... 60. So just gives you some perspective on that. You know what, as
doctors, we often get nailed as well. So that's my most... one of my more recent
CIMTs. We're going to go through some details though to begin to help you
understand how to interpret your own specific results. As I said, I usually
start with this area where the images are. This image down at the bottom is the
best one for people to get oriented because it shows the head, it shows the
nose, then it shows the common carotid artery, and the fork, the bifurcation, the
bulb. That's where the common carotid splits into the external carotid and
internal carotid. The external carotid provides blood to the face and skin here.
The internal carotid goes to the brain. This is a bone down or a drill down on
that one area in the circle, and that focus is on the bifurcation or the bulb.
Now up here, you'll see that we have more of an actual IMT picture. You see a very
narrow white line here. You see a black line and then a thick white line. So the
narrow white line is the intima layer. The thick white line is the media or
muscle layer and that black space in between is the plaque, oxidized LDL. It's
what we're worried about. Now you also see at least in this CCA
area (common carotid artery area), to get a CIMT, you want to get one centimeter of
flat space right there. And they outlined for me... they highlighted where they took
that average. Now what a CIMT does is it takes 600 cuts in that space (cuts
meaning slices on the image) and averages the IMT space at that point. That number
is what they came over here to show at what 0.68... I'm having trouble
seeing that with my old eyes and the coloring here... yeah 0.68 mm.
So what does that mean? We'll go down in just a second.
Actually, let's go down there now. You go down to see... okay, here's the male's line
this blue line, and the female's line is pink. Remember to go back up.
Most of these CIMT's will have that top image. This is again 5 years ago.
It was done with a different company so it was slightly different format. But I
have those numbers, and then I go down to the nomogram. Let's go back to the
nomogram and look at my three numbers and how you found those. So at 0.68,
that's the red number down there my original CIMT back in February of
2015. My CIMT at that point was 0.884. Well
if you go and look at 0.884, that's here where that light blue
dot is. You go over to the blue line the male's line, and you say, okay, where it is
0.884 intersect with the male line? And that is
right about there. So that's where they came up with that and said, okay, your
arterial age at this point corresponds to a 73-year-old male. Now, let's step
back even further and say, where does that blue line come from? And how did
they get that number anyway? And why is there a blue line and a pink line? Well
just to remind you, our coronary artery calcium score has radiation clearly. Most
of the stress EKGs, nuclear stress test, those kind of things,
most of those have radiation as well. But CIMT is an ultrasound technology so
it doesn't have radiation. Therefore, you see tens of thousands of every age, even
kids coming out of the womb, and CIMT of kids coming out of the womb has shown
that. Yes, many of us have started to lay down LDL or plaque before we even born
so that helps you begin to understand we had these numbers the nomogram - nomo
meaning normal, and gram meaning a picture or graph. And
the other thing that we would mention in this is that there's a blue line and a
pink line. Again help us understand that men tend to get risk for heart attack
and stroke before women. Now I've had some you know you're going it on YouTube
and you get some hater comments every time I make comments about this and men
and testosterone and our slightly more inflammatory cardiovascular status. I get
a lot of hater comments. The reality is that men get heart attack and stroke
earlier than women, and let's just leave it at that and move on. Now so that's why
you have a blue line and a pink line because again men tend to lay this
plaque down quicker than women. It doesn't mean that women don't have heart
attack and stroke. It's clearly the number one killer and disabler of women
as well. But again, back to our point, that's how you get to understand
arterial age. And when you start looking at my declining... steadily declining IMT
over that two-year period, you can understand how I reversed plaque over a
two-year period. Let's go back up and look at a couple of other things. How
about these numbers in the middle? Two things that have routinely shown risk on
in the science - one is IMT and the other one is average or mean max. Average IMT
which again you remember that that's where you get patient age. The second one
that again shows up multiple times in the science as an indicator of heart
attack and stroke risk is the average or mean max. For those of you who've spent
any time in statistics, you don't have to have spent much time at all to know that
an average or a mean is not the same as a max either, you know. So why would you
put those together? Is that an oxymoron? Here's what it is. You're taking the
average of the six largest peaks of your plaque. It's like taking a topographical
map on a cross-section where you've got flat down here where the ocean is.
But then you've got peaks up at the... up in the mountain range when you take the
top six peaks and you average those. So that's where you get the term mean max
or average Max. And that number again this is the second and third numbers
rows here in this middle section of the IMT report. That number is also very
important. Now Todd also includes a number called plaque burden. A little bit
different science behind that. Here's one of the reasons I tend to slow people
down on that. As you see on mine, if there's gonna be a place where their
numbers in red which scare people, it's gonna usually going to be in the plaque
burden. I usually have to tell people, wait a minute, just back off of that
emotional edge. This is for the most part good news because you're finding out
that you had risk before you would have found out. Otherwise, most people without
doing this sort of thing might find out that they had a heart attack risk by
dying from a heart attack. So you know now that you've got some risk, and
there's always stuff we can do to manage and decrease that risk. Now let's go in
and talk a little bit more about this section here. This is the final section
on the IMT report. And you'll see there are several different arrows here. The
first one is 1.3 millimeters. So if you have a specific area of plaque, and it's
1.3 millimeters or higher, that has also been shown to implicate some risk. You
look at all these other areas. Right CCA, for example, right common carotid artery,
no specific mentionable plaques there. If we're gonna see significant additional
plaque it's usually going to be in the bulb because of the turbulence. And yes, I
have a plaque there of 1.6 so I have some increased risk there, and you see a
number next to that 1.6. So if there is a plaque higher than 1.3 millimeters. Then
you'll get this letter S, H, or E. This is soft. It's that liquid plaque
that is dangerous. E is echogenic; it means that we're looking actually at
mostly at calcium. A tenth to a hundredth of the risk associated with soft plaque.
And then heterogeneous is starting to show some calcium specs in it. It's
starting to organize, meaning it's starting to develop some connective
tissue and stabilize. So hopefully that will help you as you begin to look at
your own numbers. Again, we're talking about several different sections, 4
sections. The first one has to do with just the arterial age, that's up here The
second one deals with the mean. The IMT is one of the two critical items, and the
second critical item is the mean max (the average of those peaks). Then the third
section here is specific plaque areas. And again if you've got an area over 1.3,
then you'll see one of these letters - soft, heterogeneous, or echogenic. And
again, soft being the ones that were really concerned about. The fourth area
is as we've discussed before that's where they have the nomogram and where
you start looking to see, okay, how did we actually get a calculation or estimate
of arterial age. This has been a long video. Again, wanted to help folks
understand a little bit more about how to read your CIMT. Thanks.
Continue to get great feedback regarding the webinars, and here's why. You know, on
the Internet when you hear a webinar, you expect for somebody to try to sell you
something. We're not doing that. We're trying to tell you something. People are
coming in with their labs from Quest - inflammation panel, OGTT, insulin survey
response - and then they're finding out, do I have inflammation? Do I have
insulin resistance? And where does that fit in terms of other folks? We're getting
ready to start one for CIMT as well. So again, people are really excited about
finding out their own status. Looking forward to seeing you there. Thanks.