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The CIMT Plaque Test for Prevention of Heart Attacks and Strokes


It is a sad fact that if you are a 60 yo man, and have 9 friends your age, either you or one of your friends will die of a heart attack or stroke in the next 10 years.  Yes, 10% of all men die of Major Cardiovascular Events in their 60s. Much of this is totally avoidable with proper Preventative Cardiology Care. Those of us who practice preventative cardiology now have several tests that can easily predict (with reasonable accuracy) who is likely to be in this 10%.  Strangely, very few American doctors order these tests, even though they are ready available.  Unfortunately, as physicians we are trained to be more interested in disease, after it happens, rather than preventing it.
One of the best tests for predicting risk of cardiovascular events is the Plaque Test or CIMT (Carotid Intimal Medial Thickness).  This test can tell with 85-95% accuracy your exact risk of a stroke or heart attack in the next 10 years.  The CIMT Plaque Test is a simple ultrasound of the neck arteries that takes only 5-15 minutes and is totally safe and painless. It measures the amount of plaque in your brain and heart arteries that have built up over the years and are blocking the flow of blood to those organs. The test, which costs less than $200 and is almost always covered by insurance, will give you a vascular age and tell you the risk of stroke and heart attack associated with that age.  For those whose vascular age is significantly higher than their chronological age, we now find that we can cause very significant plaque regression with a combination of diet, exercise, supplements and medication.  
Many of our patients are able to reduce their vascular age by 3-7 years every year, and in our practice, the rate of heart attacks and strokes among our 8000 patients has gone from 40/year to less than 8 patients/year.
You may wonder: Why do we build up cholesterol plaque in our brain and heart arteries?  It turns out that cholesterol is needed for the manufacture of the myelin that coats the nerves in our brains and hearts. The body has no central place to store cholesterol, so it stores in the arteries leading to the brain and heart, where it is most needed.  In earlier days, during periods of extreme drought, there would be no sources of cholesterol from our diet and our livers would be too weak to manufacture it. During those periods, we would use up the cholesterol we had stored in the arteries to our brain and heart.  Nowadays, even when we have droughts lasting several years, the supermarkets (and McDonalds!) are still open 24 hours a day, so we never have an occasion to use up that stored cholesterol and by age 60 (or sometime younger) a large amount of it has built up, blocking the flow of blood to the brain and/or heart.  
Unfortunately, since only about 30% of our cholesterol comes from our diet (about 70% is made in our livers), it is difficult to lower our cholesterol with diet alone. It takes certain types of diet, exercise, supplements and medication to bring down the LDL cholesterol to where it should be (<70) in many Americans with large amounts of plaque.  
 Most preventative cardiologists believe that all men over 40 and women over 50 should have a CIMT Plaque Test (or similar test).  A physician trained in Lipidology or Preventative Cardiology can do the CIMT Plaque Test and find the right combination of diet, exercise, supplements and medication that is right for each individual patient. 
Floyd Russak MD
Clinical Faculty, Harvard (ret.) and CU Medical Schools.

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