One more data point…
I’m still learning about all this… but recently listened to the Peter Attia podcast AMA on heart disease.
On Youtube: Peter Attia AMA 34 Heart Disease
His comments on this are:
How can CIMT (carotid intima media thickness) be helpful in understanding ASCVD?
- CIMT is an ultrasound that’s done of the carotid arteries in the neck
- Peter finds this to be a completely unhelpful test for a couple of reasons:
- 1 – It is so user dependent in terms of the operator
- The operator needs amazing technical skill to get a really good look at those carotid arteries
- 2 – If you will want to see a change in this, you pretty much have to have the same person doing it again and again.
- This might be that this is helpful if you have major, major carotid stenosis
- Evenstill, Peter would still prefer to to a CTA in this situation
- There are no guidelines that are based on a CIMT
- People look to this test because it has no radiation, but the CAC has virtually no radiation
“I don’t see an advantage of CIMT over CAC ”— Peter Attia
- Interpreting results of CIMT can be confusing
- A negative CIMT doesn’t tell much; it’s easy to miss things here
- Obviously if there is a lot disease in the carotid artery, the CIMT will show it
Peter prefers a CAC over a CIMT
and
The CT angiogram (CTA) is a much better test
- But it comes at a higher cost and it comes with more radiation
- At really good places, it should be in the ballpark of 2 millisieverts of radiation
- That’s a very small dose of radiation, about 4% of your annual allotted radiation, according to the NRC
- A CT scan of the heart (this one is with contrast) captures the calcification
- They typically run a dry scan first to look for calcium
- But then once the contrast is in, you can see with great illumination the arteries
- This gives a better sense of the luminal narrowing and the presence of soft plaque
