Dedicated to preventing heart attacks and strokes
For full details please go to www.shapesociety.org
Existing Guidelines for Cardiovascular Screening are Inadequate
- Stratify patients according to the Framingham Risk Score.
- More than 80% of events occur in the low and intermediate risk groups.
- Many individuals at true high risk will not be identified, and not treated properly.
- Others, erroneously classified as high risk, will be treated unnecessarily for the rest of their life.
- Clearly, this is neither cost-effective, nor good medical practice.
New Paradigm for the Prevention of Heart Attack and Stroke
We used to think that heart attacks and strokes occurred as plaque slowly plugged up the artery over many decades. We now know most heart attacks are caused by the rupture of so called Vulnerable Plaque in arteries that are about 50% occluded.
Several methods are available to image plaque:
Carotid Intima-Media Thickness (CIMT) measurement uses B-mode ultrasound with EKG
gating, and sophisticated edge-detection software. Studies involving over 37,000 patients
have shown a 90% correlation between the common carotid artery IMT and coronary
arteries. CIMT does not require radiation and can be used to follow a patient's response to
therapy over time as reverse cholesterol transport shrinks the fatty plaque.
Intravasular Ultrasound (IVUS) is the gold standard but is invasive and not readily available
Coronary Artery Calcium Scoring (CACS) requires radiation and a 64 slice CT Scanner.
It cannot be used to follow a patient's response to therapy.
Fatty plaque may thin with treatment over time but the calcium in the plaque remains
MRI is being investigated for this purpose
COASTAL CIMT uses certified vascular technologists, state-of-the-art high frequency B-mode ultrasound equipment with EKG gating, and ArterioVisionTM sophisticated edge-detection software. In addition to precisely measuring the inner two layers of the carotid artery where fatty plaque first develops, Arteriovision compares each result to individuals of the same age and sex in a California Institute of Technology database of 15,000 people to determine their "Artery Age" and their lifetime risk of a heart attack. COASTAL CIMT'S certified vascular technologists also screen the patient's internal carotid arteries for the presence or absence of lumenal plaque as part of the exam.
Coastal CIMT also assesses the plaque characteristics; something not seen in Coronary Artery Calcium Score (CACS) tests. Soft plaque is more vulnerable to rupture and can break off causing a heart attack or stroke. Early detection allows the physician and the patients to develop treatment regimens that are your best protection to prevent a heart attack or stroke.
Screening using CIMT has been endorsed by the National Cholesterol Education Program (ATPIII), the American Heart Association, and the American College of Cardiology.
You can learn more about ArterioVisionTM at www.i-mti.com
The screening strategy for risk assessment and the associated treatment algorithm of the 1st SHAPE Guideline are summarized in Figure 4 and reported previously in details (9)
What do I do with the results?
Moderate High Risk: - Treat all underlying risk factors, with LDL < 100.
- Repeat CIMT in 3 years.
High Risk: - Treat all underlying risk factors, with LDL < 70 & HDL > 40.
- Repeat CIMT in 2 years.
Very High Risk: - Treat all underlying risk factors with LDL < 70 & HDL > 50.
- Consider cardiac evaluation &/or stress testing.
- Repeat CIMT in 1 year.
- Screen family members.
