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CIMT Noninvasive testing for atherosclerosis or "hardening of the arteries"
On Mon, 27 Oct 2003 09:33:58 -0500, Mineral Mu_n wrote:
What are the reasons that a carotid measurement is used? Is it because of the common association with carotid artery dissection and strokes? carotid dissection is a rare event really. CIMT is better at predicting heart attack risk than for stroke risk because there are more heart attacks than strokes. however, it emphasizes that atherosclerosis is a global process with a predilection to certain sites in the arterial beds. exposure? Atherosclerosis begins in infancy with intimal thickening, All atherosclerosis? Or in some it begins in infancy? All. and progresses at various rates depending upon the individual. There are nearly 300 known risk factors for atherosclerosis, and some of these vary almost daily (fast food on the weekends and salads during the week for example). Are you relating sat fat intakes with (advancing) atherosclerosis? no, but more important is a 'toxic' diet high in trans fats. I am not opposed to saturated fats if trans fats are avoided like the plague. Tomorrow holds the discovery for even more risk factors. CIMT is a global measure of all risk factors however, both known and unknown. Exactly how is this procedure performed? There are many many 'protocols' followed across the globe for this procedure. Some are better than others, but it uses high resolution ultrasound to measure the thickness of the carotid intima-media interface (down to .01 mm in various segments - common, bifucation, internal and external. In my office the evaluation takes about 30 minutes and then takes me about another 30 minutes to process over 50 images on the computer. Thank you for your time. you are welcome Patrick Blanchard, M.D., A.B.F.P. Board Certified in Family Practice -- Using M2, Opera's revolutionary e-mail client: http://www.opera.com/m2/ |
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CIMT Noninvasive testing for atherosclerosis or "hardening of the arteries"
All atherosclerosis? Or in some it begins in infancy? On Mon, 27 Oct 2003 12:04:19 -0600, "Patrick Blanchard, M.D." wrote: All. Is this because everyone, to some degree, is atherosclerotic or is this only the beginning point for those who are atherosclerotic. If the former, is it the acceleration and or the accumulation of atherosclerosis that is the problem? Are you relating sat fat intakes with (advancing) atherosclerosis? no, but more important is a 'toxic' diet high in trans fats. I am not opposed to saturated fats if trans fats are avoided like the plague. Is it the combination of fats that is issue to you? Do you see any direct links from high sat fat intake and atherosclerosis? Exactly how is this procedure CIMT performed? There are many many 'protocols' followed across the globe for this procedure. Some are better than others, but it uses high resolution ultrasound to measure the thickness of the carotid intima-media interface (down to .01 mm in various segments - common, bifucation, internal and external. In my office the evaluation takes about 30 minutes and then takes me about another 30 minutes to process over 50 images on the computer. Typically, is this cost covered by insurance and what pre-testing or diagnosis or pathologies would need to be present to qualify the procedure for insurance? http://antwrp.gsfc.nasa.gov/apod/ap030724.html Lift well, Eat less, Walk fast, Live long. |
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CIMT Noninvasive testing for atherosclerosis or "hardening of the arteries"
On Tue, 28 Oct 2003 07:11:14 -0500, Mars at the Mu_n's Edge
wrote: All atherosclerosis? Or in some it begins in infancy? On Mon, 27 Oct 2003 12:04:19 -0600, "Patrick Blanchard, M.D." wrote: All. Is this because everyone, to some degree, is atherosclerotic or is this only the beginning point for those who are atherosclerotic. If the former, is it the acceleration and or the accumulation of atherosclerosis that is the problem? You are very insightful with this question! Unfortunately, aging is an unmodifiable risk factor for atherosclerosis. To some degree, yes, everyone is atherogenic (atherosclerotic). It is the acceleration (or lack of it) that results in a wide variance of atherosclerotic burden among individuals. However, I am concerned of your term 'accumulation' and want to clarify something very important regarding atherosclerosis. The process is not a deposition of gunk ON the inside lining of arteries, but is a complex cascading set of reactions INSIDE THE ARTERIAL WALL itself called the intima-media complex that begins in the very young years of life. This process is also reversible with proper therapy. Many people, including some physicians, hold an antiquated view that is not correct, still believing that atherosclerosis is deposition ON the inner lining, and that once you have it, it cannot be reversed. Not so! Many web sites, including one site from the American Heart Association, reveals the antiquated view of gunk deposition ON the inner wall lining. It is not accumulation and obstruction, but accumulation and rupture of a vulnerable plaque that kills and cripples more people every year than any other cause - and has done so since 1900 (except 1918, the year of the last great flu epidemic - did you get your flu shot yet?). Vulnerable plaques do not give you symptoms unless you are having TIAs or Acute Coronary Syndroms and cannot be detected by heart catherizations. Are you relating sat fat intakes with (advancing) atherosclerosis? no, but more important is a 'toxic' diet high in trans fats. I am not opposed to saturated fats if trans fats are avoided like the plague. Is it the combination of fats that is issue to you? Do you see any direct links from high sat fat intake and atherosclerosis? This is where we leave "tierra firma", or firm grounding in clinical science, and I don't want to debate ketogenic diets on this thread, except to say that I believe non-diabetic ketosis is metabolically sound. It was the introduction of agriculture many thousands of years ago that was simply too hard for civilizations to resist. Our bodies, however, were designed to respond favorably in chronic ketosis and was probably the main metabolic state which our ancestors were in for millions of years before agriculture. Paleolithic diets will promote atherosclerosis if you follow them haphazardly, intermixing the standard american diet (SAD) when convienient (known as the Atkins spousal abuse - on the Atkins site). Combining modern atherosclerosis therapy with strictly followed paleolithic diets is not an idea to discard. Agriculture, when originally discovered, provided nutrient dense alimentation. It has been *******ized into higher yields economically and into nutrient poor alimentation. Amarynth, spelt wheat and soy are the only grains I have found to have closely retained their original form. Exactly how is this procedure CIMT performed? There are many many 'protocols' followed across the globe for this procedure. Some are better than others, but it uses high resolution ultrasound to measure the thickness of the carotid intima-media interface (down to .01 mm in various segments - common, bifucation, internal and external. In my office the evaluation takes about 30 minutes and then takes me about another 30 minutes to process over 50 images on the computer. Typically, is this cost covered by insurance and what pre-testing or diagnosis or pathologies would need to be present to qualify the procedure for insurance? This is not covered by insurance. Do not confuse insurance coverage with cost effective and scientifically sound medicine however. 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. 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. CIMT takes the guesswork out of atherosclerosis management. 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. 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! 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. ~~~ Patrick Blanchard, M.D., A.B.F.P. Board Certified in Family Practice |
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CIMT Noninvasive testing for atherosclerosis or "hardening of the arteries"
Is this because everyone, to some degree, is atherosclerotic or is
this only the beginning point for those who are atherosclerotic. If the former, is it the acceleration and or the accumulation of atherosclerosis that is the problem? On Tue, 28 Oct 2003 07:42:31 -0600, "Patrick Blanchard, M.D." tag" ***remove wrote: You are very insightful with this question! You make me blush, lol. Unfortunately, aging is an unmodifiable risk factor for atherosclerosis. To some degree, yes, everyone is atherogenic (atherosclerotic). It is the acceleration (or lack of it) that results in a wide variance of atherosclerotic burden among individuals. However, I am concerned of your term 'accumulation' and want to clarify something very important regarding atherosclerosis. The process is not a deposition of gunk ON the inside lining of arteries, but is a complex cascading set of reactions INSIDE THE ARTERIAL WALL itself called the intima-media complex that begins in the very young years of life. This process is also reversible with proper therapy. I see. Ornish called his diet "proper therapy". Would you agree on a low to no sat fat regimen for those with serious, perhaps surgically qualified, atherosclerosis? It is not accumulation and obstruction, but accumulation and rupture of a vulnerable plaque that kills and cripples more people every year than any other cause - and has done so since 1900 (except 1918, the year of the last great flu epidemic - did you get your flu shot yet?). Eeeeks, should I? Vulnerable plaques do not give you symptoms unless you are having TIAs or Acute Coronary Syndroms and cannot be detected by heart catherizations. Yes, I understand that piece. Is it the combination of fats that is issue to you? Do you see any direct links from high sat fat intake and atherosclerosis? On Tue, 28 Oct 2003 07:42:31 -0600, "Patrick Blanchard, M.D." tag" ***remove wrote: This is where we leave "tierra firma", or firm grounding in clinical science, and I don't want to debate ketogenic diets on this thread, except to say that I believe non-diabetic ketosis is metabolically sound. It was the introduction of agriculture many thousands of years ago that was simply too hard for civilizations to resist. Our bodies, however, were designed to respond favorably in chronic ketosis and was probably the main metabolic state which our ancestors were in for millions of years before agriculture. As you said, this is for another time and place but thank you for your POV. Paleolithic diets will promote atherosclerosis if you follow them haphazardly, intermixing the standard american diet (SAD) when convienient (known as the Atkins spousal abuse - on the Atkins site). Didn't see it in the glossary, find it on a search of Usenet either. This is what? 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? 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. 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? 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? 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. http://antwrp.gsfc.nasa.gov/apod/ap030724.html Lift well, Eat less, Walk fast, Live long. |
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CIMT Noninvasive testing for atherosclerosis or "hardening of the arteries"
Paleolithic diets will promote atherosclerosis if you follow them
haphazardly, intermixing the standard american diet (SAD) when convienient (known as the Atkins spousal abuse - on the Atkins site). Didn't see it in the glossary, find it on a search of Usenet either. This is what? I am sorry, it is from the Wall Street Journal... here it is. The Atkins Spousal Syndrome: Partners of Low-Carb Dieters Suffer, Without the Benefits By KATY MCLAUGHLIN Staff Reporter of THE WALL STREET JOURNAL Alfred Gingold, a 56-year-old writer in Brooklyn, has never been on the Atkins diet. Nevertheless, his doctor blames Atkins for the uptick in Mr. Gingold's cholesterol level. The culprit: Mr. Gingold's wife, Helen Rogan -- who was on Atkins for several months this summer. She followed the high-protein, low-carbohydrate diet, and as a result the family dinner table groaned under the weight of dishes like fried pork chops and "beer can chicken" with lots of crispy skin. Though Mr. Gingold wasn't on Atkins, he was eating all that additional meat and fat -- and still chowing down on items the diet forbids, like spaghetti and bread. As a result, his cholesterol jumped about 10 points. Add a new complaint to the various beefs about the controversial low-carb diet: Atkins Spousal Syndrome. With Atkins and similar plans gaining adherents, doctors and nutritionists say the diets are having an unintended, and often unpleasant, impact on people who live with a dieter but who aren't dieting themselves. The problems range from rising blood pressure to halitosis, a common side effect of low-carb diets. "This diet is the best form of birth control," says Dayna Zizis of Bay Shore, N.Y., who says her dieting husband's breath can be a turnoff. But while a major recent study showed that a strictly low-carb diet can be healthy, spouses of dieters sometimes find themselves eating the new foods that are appearing on the table -- like more beef, cheese and butter -- and also eating the potatoes, bread and snack food that their significant other is avoiding. Atkins itself warns people not to do the diet halfway by continuing to eat carbohydrates while also adding in more meat and fat. "That's the deadliest combination," says Colette Heimowitz, education and research director at Atkins Nutritionals, the company that markets the Atkins diet. For a nondieting family member, this spells trouble. "It's kind of like second-hand smoke," says Amy Lanou of Physicians Committee for Responsible Medicine, a group that recommends a vegetarian diet. Pork-Rind Dip, Anyone? WSJ.com - The Atkins Spousal Syndrome: http://online.wsj.com/article_print/...321800,00.html (1 of 3)9/21/2003 3:24:44 AM WSJ.com - The Atkins Spousal Syndrome: While any diet of course can bring tensions into the home, Atkins can have a particularly big impact because it inspires such fervor. It has spawned hundreds of low-carb Web sites, where passionate fans sometimes praise the diet in what might be called low-carb-speak. An excerpt from Atkinsfriends.com: "LC is the best WOE for me. Even my BF says I am sweeter when I LC." Translation: "A low-carb diet is the best way of eating for me. Even my boyfriend says I am sweeter when I low-carb." Also common online: Snapshots of brides cutting low-carb wedding cakes, and recipes for treats like pork-rind dip. "They're like a cult," says Ms. Zizis, who adds that her husband follows her around the kitchen gabbing about carbs. "It's pretty annoying." Low-carb diets can have other side effects on loved ones above and beyond bad breath (which is caused by certain chemicals being released in the breath, as well as the urine, as the body burns fat). They include constipation (due to a lack of fiber in the diet's early stages) and even a full-blown case of the grumps. Judith Wurtman, who studies the link between diet and emotion at the Massachusetts Institute of Technology, says her research shows that a lack of carbohydrates can create a depressed mood. Credibility Boost The Atkins diet, invented in the 1970s, got a major boost in May, when the New England Journal of Medicine published a study showing that strict adherence to it can be quite effective for weight loss and doesn't have a significant effect on bad cholesterol. Since then, Atkins- type diets have enjoyed meteoric success. Today, nearly 2% of the U.S. population is on some kind of low- carb diet, according to NPD Group. The diet is so ubiquitous that fast-food restaurants are putting "protein meals" on the menu, and supermarkets are rolling out contradictory-sounding foods like "low carb" pasta. Much of the medical establishment believes that the Atkins diet and others like it are dangerous even when properly followed. The American Heart Association and the American Dietetic Association warn against adopting the diet, saying that there hasn't been enough long-term study proving that it is safe and effective. Breath Mints Atkins Nutritionals says studies show that mood can actually improve on the diet, and that cholesterol and blood pressure don't go up when carb intake is controlled. It also says bad breath and constipation are likely to occur only during the first two weeks, when carb intake is strictly limited; the solution is to use a sugar-free breath mint, drink plenty of water and eat fiber-rich vegetables. After the diet's initial phase, a spokeswoman says, it becomes completely healthy even for nondieting members of a household, since it includes many whole grains and vegetables. Doctors point out that many people get into trouble when they jump on the bandwagon without really understanding how the diet works. "They seem to think that the Atkins approach legitimizes eating unlimited sausage and bacon," says Tom Barnard, a general internist in Leamington, Ontario. In spite of the potential for marital distress, the Atkins diet remains wildly popular mostly for one http://online.wsj.com/article_print/...321800,00.html (2 of 3)9/21/2003 3:24:44 AM WSJ.com - The Atkins Spousal Syndrome: reason: Lots of people lose lots of weight on it. But that, too, can be hard on some spouses. For Sharon Stine, a homemaker in Conowingo, Md., Atkins Spousal Syndrome kicked in when her husband lost weight on a low-carb plan while she remained overweight and pregnant, to boot. "It really made me feel like I was this giant cow," says Ms. Stine. By contrast, her husband had suddenly become "kind of a hottie," she says. --Jane Spencer contributed to this article. Write to Katy McLaughlin at 3 URL for this article: http://online.wsj.com/article/0,,SB1...321800,00.html Hyperlinks in this Article: (1) http://online.wsj.com/article/0,,SB1...858300,00.html (2) http://online.wsj.com/article/0,,SB1...219304,00.html (3) Updated September 18, 2003 Copyright 2003 Dow Jones & Company, Inc. All Rights Reserved Printing, distribution, and use of this material is governed by your Subscription agreement and Copyright laws. For information about subscribing go to http://www.wsj.com http://online.wsj.com/article_print/...321800,00.html (3 of 3)9/21/2003 3:24:44 AM |
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CIMT Noninvasive testing for atherosclerosis or "hardening of the arteries"
Much thanks for the links.
================================================== ====== On Tue, 28 Oct 2003 09:38:10 -0600, "Patrick Blanchard, M.D." tag" ***remove wrote: The Atkins Spousal Syndrome: Partners of Low-Carb Dieters Suffer, Without the Benefits By KATY MCLAUGHLIN Staff Reporter of THE WALL STREET JOURNAL Alfred Gingold, a 56-year-old writer in Brooklyn, has never been on the Atkins diet. Nevertheless, his doctor blames Atkins for the uptick in Mr. Gingold's cholesterol level. The culprit: Mr. Gingold's wife, Helen Rogan -- who was on Atkins for several months this summer. She followed the high-protein, low-carbohydrate diet, and as a result the family dinner table groaned under the weight of dishes like fried pork chops and "beer can chicken" with lots of crispy skin. Though Mr. Gingold wasn't on Atkins, he was eating all that additional meat and fat -- and still chowing down on items the diet forbids, like spaghetti and bread. As a result, his cholesterol jumped about 10 points. Add a new complaint to the various beefs about the controversial low-carb diet: Atkins Spousal Syndrome. With Atkins and similar plans gaining adherents, doctors and nutritionists say the diets are having an unintended, and often unpleasant, impact on people who live with a dieter but who aren't dieting themselves. The problems range from rising blood pressure to halitosis, a common side effect of low-carb diets. "This diet is the best form of birth control," says Dayna Zizis of Bay Shore, N.Y., who says her dieting husband's breath can be a turnoff. But while a major recent study showed that a strictly low-carb diet can be healthy, spouses of dieters sometimes find themselves eating the new foods that are appearing on the table -- like more beef, cheese and butter -- and also eating the potatoes, bread and snack food that their significant other is avoiding. Atkins itself warns people not to do the diet halfway by continuing to eat carbohydrates while also adding in more meat and fat. "That's the deadliest combination," says Colette Heimowitz, education and research director at Atkins Nutritionals, the company that markets the Atkins diet. For a nondieting family member, this spells trouble. "It's kind of like second-hand smoke," says Amy Lanou of Physicians Committee for Responsible Medicine, a group that recommends a vegetarian diet. Pork-Rind Dip, Anyone? WSJ.com - The Atkins Spousal Syndrome: http://online.wsj.com/article_print/...321800,00.html (1 of 3)9/21/2003 3:24:44 AM WSJ.com - The Atkins Spousal Syndrome: While any diet of course can bring tensions into the home, Atkins can have a particularly big impact because it inspires such fervor. It has spawned hundreds of low-carb Web sites, where passionate fans sometimes praise the diet in what might be called low-carb-speak. An excerpt from Atkinsfriends.com: "LC is the best WOE for me. Even my BF says I am sweeter when I LC." Translation: "A low-carb diet is the best way of eating for me. Even my boyfriend says I am sweeter when I low-carb." Also common online: Snapshots of brides cutting low-carb wedding cakes, and recipes for treats like pork-rind dip. "They're like a cult," says Ms. Zizis, who adds that her husband follows her around the kitchen gabbing about carbs. "It's pretty annoying." Low-carb diets can have other side effects on loved ones above and beyond bad breath (which is caused by certain chemicals being released in the breath, as well as the urine, as the body burns fat). They include constipation (due to a lack of fiber in the diet's early stages) and even a full-blown case of the grumps. Judith Wurtman, who studies the link between diet and emotion at the Massachusetts Institute of Technology, says her research shows that a lack of carbohydrates can create a depressed mood. Credibility Boost The Atkins diet, invented in the 1970s, got a major boost in May, when the New England Journal of Medicine published a study showing that strict adherence to it can be quite effective for weight loss and doesn't have a significant effect on bad cholesterol. Since then, Atkins- type diets have enjoyed meteoric success. Today, nearly 2% of the U.S. population is on some kind of low- carb diet, according to NPD Group. The diet is so ubiquitous that fast-food restaurants are putting "protein meals" on the menu, and supermarkets are rolling out contradictory-sounding foods like "low carb" pasta. Much of the medical establishment believes that the Atkins diet and others like it are dangerous even when properly followed. The American Heart Association and the American Dietetic Association warn against adopting the diet, saying that there hasn't been enough long-term study proving that it is safe and effective. Breath Mints Atkins Nutritionals says studies show that mood can actually improve on the diet, and that cholesterol and blood pressure don't go up when carb intake is controlled. It also says bad breath and constipation are likely to occur only during the first two weeks, when carb intake is strictly limited; the solution is to use a sugar-free breath mint, drink plenty of water and eat fiber-rich vegetables. After the diet's initial phase, a spokeswoman says, it becomes completely healthy even for nondieting members of a household, since it includes many whole grains and vegetables. Doctors point out that many people get into trouble when they jump on the bandwagon without really understanding how the diet works. "They seem to think that the Atkins approach legitimizes eating unlimited sausage and bacon," says Tom Barnard, a general internist in Leamington, Ontario. In spite of the potential for marital distress, the Atkins diet remains wildly popular mostly for one http://online.wsj.com/article_print/...321800,00.html (2 of 3)9/21/2003 3:24:44 AM WSJ.com - The Atkins Spousal Syndrome: reason: Lots of people lose lots of weight on it. But that, too, can be hard on some spouses. For Sharon Stine, a homemaker in Conowingo, Md., Atkins Spousal Syndrome kicked in when her husband lost weight on a low-carb plan while she remained overweight and pregnant, to boot. "It really made me feel like I was this giant cow," says Ms. Stine. By contrast, her husband had suddenly become "kind of a hottie," she says. --Jane Spencer contributed to this article. Write to Katy McLaughlin at 3 URL for this article: http://online.wsj.com/article/0,,SB1...321800,00.html Hyperlinks in this Article: (1) http://online.wsj.com/article/0,,SB1...858300,00.html (2) http://online.wsj.com/article/0,,SB1...219304,00.html (3) Updated September 18, 2003 Copyright 2003 Dow Jones & Company, Inc. All Rights Reserved Printing, distribution, and use of this material is governed by your Subscription agreement and Copyright laws. For information about subscribing go to http://www.wsj.com http://online.wsj.com/article_print/...321800,00.html (3 of 3)9/21/2003 3:24:44 AM http://antwrp.gsfc.nasa.gov/apod/ap030724.html Lift well, Eat less, Walk fast, Live long. |
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CIMT Noninvasive testing for atherosclerosis or "hardening of the arteries"
On Tue, 28 Oct 2003 10:18:21 -0500, Mars at the Mu_n's Edge
wrote: :I see. Ornish called his diet "proper therapy". Would you agree on a :low to no sat fat regimen for those with serious, perhaps surgically :qualified, atherosclerosis? I think it is important to ask yourself just what you are attempting to accomplish with any nutrition program. Is it to boost energy, or to have ESP, or to lose weight, or to have stronger bones, or to .... you get the point. My 10 years of private practice has been focused on 1 issue however, and that is to reduce death and disability caused by atherosclerosis. Pseudoscience is rampant even in established medical communities (last century we were giving Mercury for hyptertension, a few decades ago smoking was "healthy" in some expert circles, the recent smallpox fiasco...), and I cannot accurately comment on no or low sat fats in general.There are simply too many variables. Personally I believe genetic phenotyping will help individuals understand where they came from and what foods they should concentrate on, but it will be decades until such testing is well validated. An individual knocking on the door of a vascular surgeon or a cardiothoracic surgeon with critical levels of atherosclerosis should undergo an aggressive therapy consisting of higher dose statins, tissue ACEI like lisinopril, 81 mg asa, clopidrogel, beta-blocker, fish oil, fibrates, niacin, no tobacco, no trans fats and moderate servings of naturally occuring saturated fats and protiens and complex carbohydrates for a minimum of 6 weeks before undergoing surgery if possible. Finding the best surgeon and technique for intervention is a completely different topic. ~~~ Patrick Blanchard, M.D., A.B.F.P. Board Certified in Family Practice |
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CIMT Noninvasive testing for atherosclerosis or "hardening of the arteries"
On Tue, 28 Oct 2003 10:18:21 -0500, Mars at the Mu_n's Edge
It is not accumulation and obstruction, but accumulation and rupture of a vulnerable plaque that kills and cripples more people every year than any other cause - and has done so since 1900 (except 1918, the year of the last great flu epidemic - did you get your flu shot yet?). Eeeeks, should I? yes! ( and it won't give you the flu!) ~~~ Patrick Blanchard, M.D., A.B.F.P. Board Certified in Family Practice |
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CIMT Noninvasive testing for atherosclerosis or "hardening of the arteries"
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 |
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