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  • CIMT warning

    I had been trying to do a CIMT and it seems that I should no longer be trying.

    https://baledoneen.com/blog/the-15-m...ave-your-life/

    "The U.S. Preventive Services Task Force — a group of public health doctors who issue evidence-based guidelines for medical providers — recommends against use of this scan, carotid duplex ultrasound, as a screening test for people with no symptoms of carotid artery disease, as does the BaleDoneen Method."

    Clicking through the USPSTF link says:

    "A previous USPSTF review on the assessment of carotid intima–media thickness in 2009 found insufficient evidence to support its use as a screen for coronary heart disease risk."

    https://baledoneen.com/blog/a-painle...d-stroke-risk/

    Who should be screened with cIMT? I served on the Society of Atherosclerosis Imaging and Prevention’s expert committee that developed these recommendations for appropriate use of cIMT:
    • Screening patients whose 10-year risk for CHD is moderate (6 to 20%)
    • Screening patients ages 30 or older with metabolic syndrome
    • Screening patients with diabetes or a family history of early CHD
    • Screening people with two or more of these risk factors: low HDL (good) cholesterol or high LDL, diabetes, age (being over 45 for a man or over 55 for a woman), and a family history of CHD.
    Ford Brewer; for somone in generally good health do you recommend against doing the CIMT or would you say go ahead?
    Last edited by sthubbar; 05-31-2019, 01:10 AM.

  • #2
    I agree that a carotid duplex ultrasound isn't that useful in identifying much anything until the patient has about a 70% blockage, but a carotid duplex ultrasound isn't a CIMT test. Unfortunately this is one of the most frequent misunderstandings because both use ultrasound. The difference between the two is like the difference between night and day.

    As to who would be good candidates for further non-invasive testing (CIMT test or CAC score for that matter), the list of patients that they recommend for CIMT tests sounds good to me. I don't think that there is much to gain by testing most people under 40 years of age for either a CIMT test or CAC score unless there is some family history or that person has had a heart attack/stroke/angina. Cardiovascular disease to a meaning amount for most people starts in their 40's (50's at the latest) and accelerates thereafter.
    Last edited by Tom; 05-31-2019, 01:11 AM.

    Comment


    • sthubbar
      sthubbar commented
      Editing a comment
      Tom, I clarified that the USPSTF also recommended against the CIMT in 2009.

    • Tom
      Tom commented
      Editing a comment
      As far as that recommendation from 2009, I would look around for more recent info. For sure there are a number of cardiologists who don't use CIMT testing along with even some wellness doctors. There were problems with repeatability in the past, but a well trained technician along with the current generation of software can provide repeatability. Before you give up on CIMT testing, look at a few of Dr. Brewer's videos on CIMT testing, and why he personally prefers CIMT testing over CAC scores.

      One thing for sure. I can't think of any medical guidelines which would recommend a CT angiogram as a wellness or preventative test.
      Last edited by Tom; 05-31-2019, 01:22 AM.

  • #3
    It looks to me like those guidelines were written in 2010 or earlier.

    https://www.ncbi.nlm.nih.gov/pubmed/21112055

    Comment


    • #4
      I'm not surprised about finding that CIMT is not in USPSTF standard recommendations. It's not is AHA, or ACC standards, either, is it? Given my previous work in national guidelines groups, I understand why. There aren't sufficient providers of adequate quality - the tech standardization issue Tom mentioned above. But there is a chicken-or-egg issue. Given the whole, I'd change the standards to include CIMT & specify the requirement for tech quality & standardization. The radiology/imaging community would get hit with unprecedented demand. At first, it would fail miserably. But it would respond; it's provided far more &was far better. However, there's a major problem; cardiologists would lose major income on stress tests. It's like oncologists & cancer drugs. There's a major economically-driven problem now. Stress tests (&stents) are major ATMs (cash machines).

      Comment


      • sthubbar
        sthubbar commented
        Editing a comment
        Dr Brewer, ok. I will be in Orlando, FL from June 6 - July 3. I found Life Line offering the CIMT at 2 convenient times during this period and when looking up reviews of their service there was some talk of the potential quality issues you mention. Would you recommend I go ahead with Life Line or is there another more reliable provider you suggest?
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