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Heart Attack and Stroke Prevention

It’s no surprise to most people that cardiovascular disease is the number one killer in the U.S., taking the lives of over half a million people annually. What may be news to some is that over half of those deaths are unexpected because they occurred in people who never knew they had vascular disease. These are primarily people who had no prior symptoms, felt great, had normal cholesterol values, and may have even received a clean bill of health from their physicians prior to their very first symptom: a fatal heart attack or stroke.

The problem is simple: current protocols for detecting heart disease in patients with no symptoms are basically non-existent. After all, if you’re not complaining of chest pains, shortness of breath, nor have other recognizable indications, and if your cholesterol is fairly normal, what would prompt your doctor to look more closely for it? Besides, insurance companies are unlikely to cover the cost of what they would categorize as a preventative test, unless that test comes back positive. Insurance companies pay out for sickness, not prevention. Odd, considering that prevention is far less costly than sickness!

Without complaint of specific symptoms, the doctor sees no reason to order tests. The Catch 22 here is that any doctor knows that over 300,000 undiagnosed people die without warning every year from this disease! They even acknowledge that some of those people are very possibly in their own practice! In fact, it is the asymptomatic patient which makes cardiovascular disease the number one killer in the U.S.! If there was some way to identify the disease in these people, the number of deaths every year would drop significantly enough to take cardiovascular disease off the top of the list! It’s a huge problem and doctors know it, but unless there is evidence of disease there’s not much they can do.

Or is there?

In fact, there is. There is a safe, non-invasive, highly accurate, relatively inexpensive test that can visualize actual disease in the arteries. It is recommended for any person over the age of 45, and for any person with two or more risk factors for heart disease, regardless of age. Despite the fact that it is targeted toward people with NO symptoms or other evidence of the disease, doctors who are recommending this test for their over-45 patients, or patients with some risk factors such as family history, obesity, insulin resistance, and so on, are finding that upwards of 60% of them do have problems that require attention. Sixty percent!

The test is called a CIMT scan. It is an ultrasound scan of the carotid arteries, and it does several important things. It can detect narrowing of the arteries, but this is actually not its main purpose, because severely narrowed arteries cause symptoms and alert patients and physicians of a potential problem which is addressed through established protocols. The scan, however, also visualizes inflammation within the layers of the artery wall, and this is where the greatest hazard lies with respect to hidden disease. In the arterial wall, the growing inflammation and plaque does not obstruct blood flow, and therefore it causes no symptoms. It might not affect cholesterol levels or blood pressure. In fact, you might feel great! But it’s in there, and it continues to build and spread until it eventually ruptures through the wall, resulting in a heart attack or a stroke within a matter of seconds.

The CIMT scan can also determine the nature of the plaque; that is to say, whether it is hard plaque (which is fairly stable and unlikely to break off and cause a thrombosis), or soft plaque, (also known as vulnerable or unstable plaque, and is the more dangerous of the two). Finally, the CIMT scan can, with a high degree of accuracy, be used as a five-year predictor of a cardiac event if the disease is allowed to progress without intervention.

At present, there is no other accurate, non-invasive, and affordable means for finding hidden atherosclerosis. Yet, neither the general public nor most physicians are familiar with it.

CIMT scanning as a preventative measure is relatively new, though approved by the FDA, and endorsed by the American Heart Association, and there are only a few companies offering it to physicians which are able to guarantee a high level of accuracy. And, because they are already overburdened, doctors are not often willing to take the time to hear about yet another new device or service they can bring into their practice, even one as important as CIMT. Therefore, the few companies that do offer the service are finding it difficult to convince doctors to incorporate it into their practice, particularly when there is no guarantee that insurance will pay for it. Most doctors are reluctant to recommend anything which the patient might have to pay for out of pocket, because they assume that either the patient will not be willing to spend the money for it, or that it will be more difficult to collect from them than from insurance providers. In the end, it’s just easier for them to say, “Not interested” or to continue their standard protocols. Unfortunately, standard protocols leave hundreds of thousands of people in grave jeopardy.

The cost of the test is generally under $200, takes ten minutes, and will accurately determine whether disease is present. A small price to pay, considering the epidemic of sudden fatal cardiac and cerebral events we deal with in this country every day, to say nothing of the tremendous financial burden placed on all of us for having waited until a catastrophic event occurs. Are there other, more commonly established tests available? None that are as inexpensive or as non-invasive (and therefore, no risk).

In time, no doubt CIMT scanning as a preventative measure will become as standard as mammography. Hopefully that will happen soon, because if you consider that most women over 50 are getting mammograms yearly, yet cardiovascular disease kills ten times more women every year than does breast caner, the disparity is rather obvious and more than a little absurd.

Unfortunately, until then, people will continue to die unnecessarily. It appears the only way to expedite the process is for you, the patient, to be your own advocate. Be informed, demand that your doctor bring the test into his or her practice and make it available to you; and make sure the decision to pay or not pay out of pocket, in the event insurance won’t cover it, is yours to make, not your doctor’s!

Bottom line: If you or someone you love is over 45 years of age, or if you have two or more risk factors for heart disease, do yourself a favor. Talk to your doctor about CIMT scans and, if he or she is not familiar with it, ask that them to find out about it. If they are not willing to, or tell you it’s not important, perhaps you should be looking for a new doctor. Your life may well depend on it!