The Value of Vascular Imaging for Reducing Heart Attack Risk
Do you have high cholesterol?
A family history of heart attack or stroke?
Do you smoke?
Have high blood pressure?
Are you overweight?
Do you have diabetes?
These are some of the typical things that might be assessed by a primary care physician or cardiologist in an effort to calculate your risk for a future heart attack or stroke. Seems like a pretty thorough list right? With one person dying from cardiovascular disease every 34 seconds in this country, it better be.
Unfortunately, however, while it appears to be a thorough list, it is not enough to get a truly accurate assessment. In fact, recent research has shown the standard risk calculators that incorporate this type of information, and which are employed by most doctors, are insufficient for helping to accurately determine your true level of risk.
A recent analysis of some of the most commonly used calculators revealed a hodgepodge of results showing them to sometimes overestimate and sometimes underestimat risk, but rarely do they hit the nail on the head. Long story short, relying on a CVD risk calculator as the sole means of assessing your future potential for a heart attack or stroke and/or to help you decide on starting to take a medication or to pursue other efforts to reduce risk will leave you with little more than an educated guess. Unfortunately, however, this is still the standard of care in conventional medicine.
A Better Way
My training in, and use of advanced risk assessment for heart attacks and strokes for the last 10 years has shown me that, if one is willing to dig a little, there is much more that can be done to identify your true cardiovascular health status than what is typically happening out there.
Perhaps the most important thing of all that we can do is simply to look.
Coronary artery calcium scoring (CACS), along with carotid intima-media thickness (CIMT) ultrasounds are two tests I use frequently with my patients. CACS is available with a doctor’s order at most imaging centers, and is a non-invasive, relatively safe, and very inexpensive way (most centers charge around $100-200) to get a look at your coronary (heart) arteries. It uses a CT scan to look for evidence of calcium deposits in the walls of your arteries, which only occurs if there is plaque in that region. Research shows it can add significant value to any standard effort at risk assessment. The downside is that the younger a person is, the less likely it is for their body to have calcified any of the plaque present in their arteries, and so it will miss non-calcified lesions in a subset of the adult population. My age cutoff for recommending this test is about 50 years old for the average biological male, and 55 years old for the average biological female. It is also not a useful test for following disease progression or regression as I work with a patient, unlike CIMT (more below).
CIMT ultrasound is another inexpensive, non-invasive, safe, and useful test that can be employed in an effort to obtain a much more accurate assessment of risk for future heart attacks and strokes. Recent research also shows it can be very useful to help predict risk for future cognitive impairment. In my practice, I also find it incredibly helpful for obtaining true, objective evidence regarding how my patients are responding to the treatments I recommend, year in and year out. It is one thing to see cholesterol levels go down, but entirely another to see actual visible evidence of arteries getting healthier.
The downside of CIMT has typically involved a combination of lack of availability and less reliable results in the face of inexperienced or poorly trained ultrasound technicians. For this reason, my clinic uses Cardiorisk Laboratories, who represent the gold standard in the industry, on a monthly basis, and we now serve as a hub for this type of testing for other doctors in the region to send their patients.
Considering the fact that cardiovascular disease is so common it can even be found in fetal arteries and that it affects nearly half of all Americans, it is my humble opinion that everyone should have at least one thorough evaluation for cardiovascular disease risk, and these imaging studies are a crucial part of that.
In a future article, I will discuss the lab tests that can be employed to get a better understanding of certain aspects of risk that go far, far beyond the typical standard lipid panel used by so many doctors.
For those who are really interested in learning finer details about preventing heart attacks and strokes, I highly recommend checking out my forthcoming full day webinar on this very topic. Continuing education for naturopathic doctors is pending!