By Ralph Golan, MD

5-Minute Test Reveals Your Risk for Heart Attack or Stroke
There is an important test we have been providing since 2005 - carotid artery IMT ultrasound scanning. This FDA approved five-minute painless test gives us information that can help prevent a heart attack or stroke. Hundreds of digital measurements are taken as the technician gently rubs the ultrasound probe over each side of your neck. We can see precisely how thick the artery walls are (specifically the intima and media sections), and it is this measurement that determines your risk of a heart attack or stroke and actually gives us a calculation of your arterial age.

Soft Plaque Increases Your Risk for Stroke;
Test Reveals Your Soft Plaque Levels
The scan also demonstrates the presence and size of any arteriosclerotic plaque, whether the plaque is calcified or soft, and these findings are also weighted into your overall risk. (Soft plaque is the more dangerous kind as it can rupture and become a thrombus—clot.)

Radiation-Free Carotid Artery Scan Has Advantages
Over A CT Heart Scan
There are two distinct advantages of this carotid scan over the CT heart scan done directly on the coronary arteries. Both tests can demonstrate calcified plaque, but it is only the carotid ultrasound that identifies soft plaque, and it is quite common for an individual to have significant soft plaque whether or not there is calcified plaque. The other difference is that the CT heart scan involves a sizable dose of radiation which the ultrasound does not.

IMT Ultrasound is More Sophisticated
Than Other Carotid Artery Ultrasounds
Officially termed “Carotid Artery IMT Ultrasound” (IMT stands for Intima-Media Thickness), this type of ultrasound is far more sophisticated and gives us far better predictive information than the more common type of ultrasounds that are advertised in the mail and newspapers -- the ones that come around in trucks to your neighborhood. This scan shows how much occlusion is present, but the report does not distinguish between soft and hard plaque--which can be critical information for treatment decisions, and they do not measure the all important arterial thickness or provide arterial age.

Benefits of Testing the Carotid Arteries in Your Neck
There is a 96 percent correlation between the health of your carotid arteries in your neck and the coronary arteries in your heart. What we gain in studying your carotid arteries is the information that will tell us what kind of cardiovascular risk you have and therefore what measures we need to implement to prevent our country’s most common cause of death and disability – cardiovascular disease. We would know if your successful cholesterol lowering efforts are protecting you enough because we can actually see and measure what is happening in the artery, not just make an assumption from your favorable or unfavorable-looking blood cholesterol levels.

Discover How Effectively Your Healthy Habits are Lowering
Your Heart Attack and Stroke Risks
You may already know that favorable cholesterol levels are not necessarily protective. Approximately one-half of all the Americans who are struck with a heart attack every year do not have worrisome cholesterol levels. We can actually see, looking at the Carotid IMT Ultrasound, if your weight control or blood pressure control or blood sugar and insulin lowering efforts or stress management measures are enough or not in terms of the actual and measurable effects on your arteries. We can see if a family history of heart disease is affecting your arteries or not. Seeing is knowing!

With the information we obtain from this test, we know whether or not your current efforts are adequate, and if not, we can add to or modify your treatment with a safe and effective program to reduce your risk factors—whatever they may be. We can perform tests to determine what your risk factors are if you have not yet had them.

New Screenings Help You to Evaluate and Reduce
Your Cardiovascular Risks
You have no doubt had a cholesterol screen, but have you had your LDL subclasses measured? If your total LDL cholesterol is not too worrisome, you could still be at risk if you have too much of the LDL III b or IVb small particles. Conversely, your respectable HDL level may not be so protective if your HDL consists primarily of the HDL 3b and 3c small particles. Or have you had your homocysteine or high sensitivity CRP tested? Or lipoprotein (a) or Apolipoprotein A1 and B or fibrinogen or heavy metal screening?

If your carotid scan shows some plaque or thickening and we do not know what factors have led to this build-up, we can obtain some of these tests or others and take appropriate measures to lessen the risk factors and actually reduce the thickness of your arteries and size of the plaques. We also can perform a blood test that determines your genetic predisposition to a high LDL cholesterol level and what surprising dietary measures, according to your genes, would improve or worsen your LDL level.

New Ways to Reduce Inflammation and Plaque -
and Improve Arterial Health
We now know that it is inflammation that is the root of increased thickness of the arteries and that plaque originates from inflammation. There is so much now that we can do to control inflammation, stabilize and even regress plaque, reduce or abolish angina, and prevent a premature cardiovascular event from happening. I offer both oral and intravenous nutritional therapies as well as pharmaceutical meds, if required, that are effective in lowering your risks. And we will actually know with such a precise re-measurement of your carotid arteries in six to twelve months if we are on track. With before and after Carotid IMT ultrasound studies, we have documented in many of our patients that our treatments reduce plaque size, arterial thickness and arterial age!

Do You Have Risk Factors for Heart Attack or Stroke
That Indicate a Carotid Artery IMT Ultrasound Scan?
The carotid artery IMT scan is indicated in anyone over 40 years old who has had high LDL cholesterol or triglyceride levels, low HDL cholesterol, high blood pressure, diabetes, metabolic syndrome or elevated insulin levels, overweight, family history of cardiovascular disease, elevated homocysteine or high sensitivity CRP levels, elevated heavy metals (lead, mercury, cadmium), elevated lipid peroxides (free radicals), cigarette smoking history, and rheumatoid arthritis or other inflammatory / auto immune disease. (Did you know that those with rheumatoid arthritis have a many fold increase in heart attack incidence compared to others without this condition? Inflammatory /autoimmune diseases, while demonstrating their obvious symptoms such as pain and fatigue, can silently and steadily be inflaming the arteries, producing thickened arterial walls and plaque.)

Heart Disease or Stroke History?
This Scan Measures Your Treatment Success
The Carotid IMT ultrasound is also indicated for persons with known heart disease or stroke history as a non-invasive method to track the success of their treatments. It is also useful in persons under 40 years of age if they have any of the above risk factors. And the test is available for anyone, regardless of age or risk factors, who just wants to know the health of their arteries.

Increased Arterial Plaque Risks for Women on Birth Control Pills
for 10+ years
Recent research has disclosed that being on birth control pills for ten years or more increases the likelihood of arterial plaque developing, even in women as young as 33 years old. The study demonstrated that taking birth control pills for ten years increases the likelihood of developing arterial plaque by twenty to thirty percent. Though the studies are not in yet, it may be that more than ten years of use will push these numbers above 20 – 30 %. So, here we have another risk factor for arterial ageing, thickening, and plaque: ten years or more of birth control use--whether in current use or even having stopped 10 years ago. This risk alone, and especially in combination with other risk factors, would make one a very good candidate for a Carotid IMT ultrasound.

Is the Carotid Artery Scan Too Good To Be True?
Remember I mentioned 96% accuracy to this test. The only downside (be it small) of the 96 percent correlation between the carotid and coronary arteries referred to above is that four out of every one hundred people who have the ultrasound scan on their carotid arteries may not show up any plaque or thickening there but could still have these changes in their coronary arteries. In such patients, their particular histories, risk factors, and possibly other tests would tell us whether or not these patients are at risk.

Where and How to Get a Carotid Artery IMT Ultrasound Scan
The test fee is $175. If you have insurance that will reimburse you for visits to my office, this test is usually insurance reimbursable. If your insurance does not pay for visits to me, then the test will be an out-of-pocket expense. We would have a visit to review the findings when the results come back – in one to two weeks.

Get the Answers You Need About Your Heart Attack and Stroke Risks
Please contact us for the next available date or for more information, 206-524-8966. We usually offer this test every other month in our Seattle office. One does not need to be an established patient in our office to have this test done here. If your spouse/partner or any family member or friend is interested in having this test, have them schedule. We will give them the results to take to their own physicians, or they can schedule an appointment with me to review the results.

Return to Dr. Golan’s Article Archive or get more information about heart attack and stroke risks at www.cardiorisk.us.

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