You know I keep pushing for more CIMTs and I feel a little bit about like the
old Maytag repairman. Nobody's interested. Actually, there are a ton of people that
are interested... that are looking deeper at preventive services but here's part
of the reason why I'm going to show one of the pieces of science out there
comparing coronary artery calcium score and ABI with CIMT.
What is ABI (ankle brachial index)? You take your blood pressure in your arm
your break-in and your ankle and you look at the differences. If there's a
significant amount, the theory is this: if there's a significant amount of plaque
in between like in the aorta and the pelvic walls, that'll decrease the blood
pressure getting down to the ankle. And it does work. As you'll see in this, it
really works more for folks that have higher risk already. We know they have
risk but it's an acceptable way to follow people and
to (again) look at risk. What did we find here and what was the
problem? Why did CIMT not show up as well? We'll
get to that just a minute. So, "Comparison of coronary artery calcification,
the carotid intima-media thickness and ankle brachial index for predicting 10-year
incidence of cardiovascular events in the general population." This was in the
European Heart Journal of 2017.
They quantified CAC, CIMT, and ABI in 3,100 patients, followed them for about
10 years. It was in a study that was already existing - the Heinz Nixdorf
Recall study that was in the Ruhr region of Germany. So their read on it is
that over the past two decades, there's been a growing acceptance of some type
of study to help or procedure to help differentiate risk for people that are
at low risk for heart attack and stroke, at least according to Framingham, and
history-based surveys like that. Now we used to... and you still see tons of it... it
used to be accepted to do stress tests. What's happened is this, and let me just
warn you off of this. One of the more common assumptions from yeah the healthy
worried group is to go to their doctor, their internist or cardiologists, their
family practitioner, and say, "Look, I just you know I'm I know you tell me I'm in
good health but I just like to get a screening test anyway." If you are the doc
or if the doc suggests a stress test, run the other way and here's why. I cannot
tell you the number of people that have something come up on a stress test even
though they were healthy. And if you get something on a stress test,
you're now very worried, the docs worried, and the only way to figure that out is
angiogram. So once you start doing an angiogram (that's an invasive study), that
results in significant injury, and it has over and
over again so and there have actually been studies
showing that the probability of somebody having a problem is much greater if they
go get a stress test. If they're in the low-risk category so just don't do it. So
they're still working through the current guidelines on when to do.
Coronary calcium, CIMT, and ABI. There were changes in '09 where they
started to agree to those... that was actually one year by the way after the
death of the very highly publicized death of Tim Russert, another one of
these guys that fit into this "low risk" category and who was found after
his death upon autopsy to have arteries that were full of plaque.
He had a destroyed... a ruptured plaque that caused a heart attack. So again for
this study, the recent data suggests that these may not be equally defined at the
end of this day. Here's what they found. They took German Ruhr residents. They're
already in that Nixdorf study... Nixdorf Recall study. Ages 45 to 74.
Ultrasound on the right and left. They did I just IMT, no mean max and again
this just underlined lines that there are no standards yet. For the CIMT,
3,108 study participants and
they had what about 200 I think events during that ten-year period. So that
equals out to a low-risk population about seven and a half percent events
over that 10-year time period. Here was one of the keys images that they showed
in the study and here's the again what they did. They just dichotomize. They
figured out how can we create a dichotomy to show the difference between
these a positive score and a negative score. Well again those of you who are
familiar with the CIMT, you're looking at arterial age or IMT, and you're
looking at risk associated with mean max. In other words the number of high peaks
that you have in terms of arterial plaque, it's sort of like trying to
shoehorn that into their own type of standard. It did show a difference and
actually they admitted later on in the study that CIMT was maybe a little
bit better for the low risk group. However, at the end of the day, they said,
"Let's use coronary artery calcium score." What's my perspective? I would just be so
happy if the insurance company would quit reimbursing stress test for
low risk populations and reimburse all three of these that would at least
be such a step forward. Before I turn this into a rant, I'll sign off.
Thanks for your interest. So you've been asking about it. When's the CIMT access
tour? Starting Anaheim LA September 28th. David Meinz will be there with some
with a CIMT tech. It's about 250 bucks for the whole afternoon plus the CIMT
plus the reading on the CIMT. If you have further interest, you can sign up at
CardioRisk.US/HealthyLife.