I'm going to finish up with talking about IMT intima-media thickness tests
we do it on the carotid artery
well that's not in the heart why are we doing that there we just looking for stroke no you go
back and you remember this is a systemic issue plaque is a systemic issue it doesn't happen in
just one artery as I said a minute ago 80 percent of plaque in population wide appears to be due to
blood sugar problems prediabetes and for those of us who have full-blown diabetes diabetes
again same issue same metabolic problem just a matter of degree now CIMT is a new way
of looking at this new as of what 40 50 years ago and it has struggled this one graph shows why CIMT
is so important it's this group right here this people what they did was they took about 10,000
people and they did CIMTs on they separated them into people that had these levels of plaque none
just over one millimeter plaque in the wall only and then plaque obstructing the flow
the probability of having a heart attack over the next 10 years if you had plaque obstructing
the flow was 81.1 percent that's the people that would have had a positive stress test
if you had less than one millimeter or on the area of one millimeter your probability of having an
event over the next 10 years is still less than 10% but here's the people that CIMT makes a huge
difference for it's more than one millimeter but it's not blocking the flow remember a stress test
is only going to be positive if you're blocking the flow so these people had a 40% probability of
having a cardiac event over the next 10 years but yet they would have had a negative stress test so
why are we still moving so slow on doing a stress test because it is a major challenge in terms of
getting it right and the science therefore is you know it's a garbage in garbage out thing so many
people have done CIMTs wrong and they put that they reported it they put it in the science so
it comes out looking like garbage I would recommend and i get this because i talk about CIMT
a lot of people come to me with a locally done CIMT there are three or four places in the country
where I've seen them done well the vast majority of places they're not helpful there's a group in
Atlanta there's a group in la and there's a group in Nashville all of them are only in those towns
there is one national group what they do is they send texts all over the country I've got plenty of
patients that are getting CIMT in New Jersey New York Utah California Southern California
Florida you name it and they're getting it through that national group it's called CardioRisk and
I don't make any money from CardioRisk Todd and I are actually getting ready to publish a book
though about this topic plaque how to measure it this is an image of a CIMT and here's what
you're looking at the common carotid artery here and then that separates into the internal carotid
artery and the external carotid artery I know that because this one's bigger the bigger artery
supplies the brain and the lesser one supplies the muscles of the face if you have a plaque greater
than 1.3 millimeters and if you're gonna get one discrete plaque it's going to be right here this
is you know you just think about hydrodynamics if you've got a hose and it splits apart you
start getting chaotic flow patterns it's not a smooth flow anymore so you're much more likely
to get deposition but a CIMT when you're looking at intima-media thickness test this is where
you're looking it's in a flat space one centimeter long in the common carotid and you're looking at a
couple of different areas this thin white line is the intima it's that single-cell layer lining the
artery wall the part that we talk about getting burned when you have inflammatory problems like
episodes of too high blood sugar too high insulin rheumatoid arthritis smoking things like that
this thick white line is the media it's the muscle cell of the artery wall lining it's what keeps the
artery from blowing apart you know blood pressures of 120 over 30 it would blow apart the artery if
it just had that simple little intima structure so the black structure in between the intima
and the media is where plaque happens it's where cholesterol LDL if you have inflammation of this
intima lining LDL starts seeping through there but it won't go through the muscle layer the
media layer so it gets stuck right here and that's what we're measuring when we're measuring the IMT
intima-media thickness it's also how we're estimating arterial age you know you hear me
say in the mid 50s I had an artery age of 73 that's because I had that much plaque buildup
and again I think we talked about why so this is Todd obviously not a great image but he's
appeared with us several times helping people understand the intima-media thickness test
so I'd like to talk with you a minute about the webinar people don't understand what the webinar
is it's actually a great way to get some access to health care that you're just not going to
get any other way you actually get the lab tests yourself for at a local lab a Quest lab near you
for the inflammation panel and the OGTT and the insulin survey these are things inflammation and
prediabetes that your doctor just does not know about and here's the thing Harvard Health and many
others have said look sudden death is not always so sudden the Hollywood picture that it's evolved
out of the blue is not realistic it's more like real lightning preceded by clouds wind and rain
stop that metabolic storm before the lightning strikes and here's where that metabolic storm
comes from it's inflammation and it has to do usually with prediabetes so again we actually
get labs we go over them in the webinar and then you can start finding out how you can
prevent that heart attack others said that you couldn't even predict we can show you how thanks