On Tue, 28 Oct 2003 10:18:21 -0500, Mars at the Mu_n's Edge
wrote:

CIMT is not covered by insurance. Do not confuse insurance coverage with
cost effective and scientifically sound medicine however.

I understand managed care all too well. However, there are instances
where proactive measures can be covered by insurances.

Because the majority of heart attacks and strokes are from clinically
evident atherosclerosis, and because there are decades of preceeding
clinically silent atherosclerosis, I recommend CIMT for people age 30
and above.

Cost?

375.00 USD for the test itself, performed by me currently.


The American Heart endorses CIMT for people identified as 'intermediate'
risk by Framingham data and want to know if they are 'high risk' (in
other words, the Framingham risk profile may not have identified high
risk). Framingham data (age, smoking, cholesterol, blood-pressure,
family history, diet, exercise... is terribly inaccurate for assesing
risk and has been shown to miss over 50% of individuals at risk for
heart attack and stroke.

Or you could say it is successful 50% of the time.

you are an optimist!


CIMT takes the guesswork out of atherosclerosis management.

How often would you get a result from CIMT that you would consider to
be inaccurate? How would you now if a result is accurate or not?

This is a question about protocol. Annual CIMT evaluations will give you
the earliest information about trending, or the progression or regression
of global atherosclerosis (including coronary arteries), as long as the
protocol is performed exactly the same way, with the same high resolution
ultrasound. An accurate protocol is difficult, time consuming, and surveys
3 major flow segments of the carotid system that mimic remote arterial beds
(like coronary, brain, aorta, renal, extremities) : low flow, low pressure
(internal), vortex regions (bifurcation), high flow high pressure
(external), medium flow medium pressure (common), each at near and far
walls, and 4 different scanning angles 15 degrees apart. You can find other
CIMT protocols (like Univ. of Wisconsin, Loma Linda to name 2 of them) but
they are lesser quality in my opinion, and do not focus on trending.


Also a lesser well known problem with Framingham data is how it is often
it is improperly used to calculate risk after intervention. For example,
if you have a high risk score on the Framingham questionaires because
you smoke and have high cholesterol, and you undergo treatment,
Framingham data is no longer valid and never will be valid for you
again. Framingham data is used for initial pre-treatment assesment only,
and becomes invalid the moment you change your risk factors with
therapy.

I see the point.

Therefore, if you have taken statins a few years ago and then quit, the
Framingham data is inaccurate. CIMT however, delivers global assesment
of your risk, and takes into account all of your past risk factors and
can then asses your progress in therapy (of lack of) like no other tool!

Is there cheap stock available?
let me know if you find some, but I don't own stock anyway.

Modern therapies can reverse atherosclerosis AT ALL STAGES, and should
be initiated on individuals identified as having it. Children with
hypercholesterolemia have been shown to have increased CIMT readings
that improve with proper therapy, and I recomend the evaluation to
children and adolescents with strong risk factors (using the Framingham
data). High resolution ultrasound has 40 years of proven safety in all
age groups. I refer you to www.pubmed.gov for references. Simply search
"carotid intima media" as a starting point.

Thanks again.
Thanks for the workout!


http://antwrp.gsfc.nasa.gov/apod/ap030724.html
Lift well, Eat less, Walk fast, Live long.


~~~
Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice