I bet this test could have predicted my event. I wonder where the recommendation will be published. and how will they make sure both my doctor and my Dads' doctor will understand and recognize that doing this can prevent strokes. Do you really think your doctor will know what to do?
http://www.medpagetoday.com/MeetingCoverage/AdditionalMeetings/32175
Determining one's vascular age via an ultrasound of the carotid
intima-media thickness (CIMT) can help triage the so-called "worried
well," a small study found.
In an effort to test the robustness of CIMT-adjusted risk, Lori Neri,
CRNP, CLS, and colleagues from The Heart Care Group in Allentown, Pa.,
assessed the carotids of 26 patients with a first-time ST elevation
myocardial infarction (STEMI) and no known prior cardiovascular disease.
They found that the CIMT-adjusted vascular age was significantly higher than the chronological age (79.5 versus 52.8 years, P<0.001).
In addition, although the Framingham risk score put 7.7% of these
patients into a high-risk category, when the CIMT-adjusted age was
added, 42.3% were classified as high-risk, Neri reported at the
Preventive Cardiovascular Nurses Association meeting in National Harbor,
Md.
STEMI patients are typically in their early 50s, generally younger
than those with acute coronary syndromes, and they may not appear as
obvious candidates to be at risk for heart disease.
"That's why it's important to find a way to identify those whose
Framingham score does not categorize them as high risk but who in fact
may have an elevated risk," Neri told MedPage Today.
The American Heart Association/American College of Cardiology
guidelines say it's reasonable to use CIMT assessment in asymptomatic
adults at intermediate risk (class IIa, level of evidence B).
The guidelines state that CIMT has been independently associated with
future risk for ischemic events in middle-age individuals and that the
risk is linearly associated with the artery thickness.
Neri, who is the director for the Center of Cardiac Risk Prevention
at The Heart Care Group, said she gets a "fair amount of the worried
well" in the clinic. These are people in their 50s with a strong family
history of heart disease who are concerned about their own risk.
These people always undergo the usual risk assessment tests. If there
is something that stands out, such as an abnormally high cholesterol,
Neri will recommend the CIMT scan.
Co-author Martin E. Matsumura, MD, had previously shown that the Framingham risk score misses about 60% of patients presenting with a first STEMI. In this group, Matsumura said, the Framingham score "overemphasizes age as a risk factor."
The CIMT test uses an ultrasound probe to image the inner lining of
the carotid arteries for subclinical plaque. Software calculates the
vascular age based on the thickness of the lining.
"It's a sensitive and reproducible test," Neri said, adding that
operator experience is crucial to obtaining high-quality results.
Insurance does not cover the test, but patients can have it done at
Neri's clinic for under $50. "We started out charging $199, but
continually dropped the price because we feel strongly about it's use
and importance," Neri said.
She estimated that three out of every 10 people who get the test will
have a vascular age that is higher than their chronological age. These
people are then treated aggressively for preventive care.
For the study, Neri and colleagues assessed the carotid arteries of
26 patients within 30 days of admission for a first-time STEMI. Patients
had no prior history of coronary artery disease, diabetes, peripheral,
or cerebrovascular disease.
Researchers defined a vascular age for each patient based on an
algorithm derived from the Atherosclerosis Risk in the Communities
(ARIC) database and then re-calculated the Framingham risk score with
the addition of the vascular age.
While the mean patient age was 52, the mean vascular age was nearly
80. Using the Framingham risk score, only two out of the 26 patients
were considered at high risk for a heart attack. Adding the CIMT
assessment boosted that number to 11. Neri said they are still analyzing
the data to determine what other factors might help identify the
remaining nine patients who had a STEMI.
The cohort as a whole had a mean 10% risk of a heart attack based on
the Framingham score, which increased to 17% with the addition of the
CIMT assessment.
"Our results suggest that a CIMT assessment may help improve risk
stratifying in asymptomatic patients with a strong family history of
heart disease and one or two risk factors," Neri concluded.
She added that patients who see they have an older vascular age are
often much more motivated to change their lifestyle and comply with
medication adherence.
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