Having introduced the idea of advanced cardiac testing in the previous two posts, I will now get into specifics. Preventing heart attack and stroke is greatly aided by early detection of arterial disease. When looking for early and asymptomatic cardiovascular disease, using ultrasound to look at the carotid arteries and measure carotid intima-media thickness (cIMT) and plaque is arguably the best initial study. The test takes about 10 minutes, can be done in the doctor’s office, is painless and does not require disrobing. Furthermore, it is relatively inexpensive, non-invasive and brings no radiation exposure or other risks. It measures the thickness of the inner two layers of the carotid artery wall and looks for soft plaque. These measurements are correlated with risk for heart attack and stroke which allows for earlier intervention if disease is found and avoidance of medication if arteries are clear. The finding of soft plaque is especially important as these are the plaques which can rupture causing complete blockage of arteries. The good news however is that they can be reversed by appropriate care. The intima-media thickness, based on population studies, allows us to calculate an arterial age which can then be followed to see if progress is being made. I recently spoke to a man who took 12 years off his arterial age and was delighted as well as very motivated to continue a healthy lifestyle. Looking at these pictures also provides a level of motivation for change which discussing lab numbers rarely does. We love having concrete images to augment lab values which alone are frequently misleading. As mentioned, theses studies are as likely to help us keep a patient off medication as they are to prompt its initiation. Cost effective cIMT will soon be available for Trinity patients. The other helpful imaging test for screening is the Coronary Calcium Score (CAC) which complements the cIMT and is the test Trinity doctors have been ordering to this point due to it’s reasonable price. I’ll talk more about CAC in the next post.