Ralph Golan, MD
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.
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.)
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.
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
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.
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
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.
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!
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.)
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.
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.
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.
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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