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The CIMT Test: Worth the Cost?
Cardiovascular disease is the number one cause of death for both men and women, so it stands to reason that anything we can do to detect it as early as possible could be potentially life saving. The most important risk factors for heart disease and stroke include high blood pressure, diabetes, high LDL cholesterol, smoking, obesity, lack of exercise, and family history of early heart disease. Many physicians use the Framingham Risk Score to help to estimate an individual’s risk for heart disease over the next 10 years. Since the Framingham score doesn’t take family history or body mass index into account, the British QRisk2 Score may be more helpful. But there are still people that these scores may classify as low or intermediate risk that will eventually go on to develop heart disease.
The Carotid Intima-Media Thickness (CIMT) test was developed to help identify those individuals at higher than conventionally predicted risk for cardiovascular disease. The test is performed with ultrasound, and measures the thickness of the carotid arteries, which supply the brain. The idea is that increased thickness of these arteries is a marker for early heart disease. The CIMT test is quick (usually 10 minutes), painless, and involves no radiation exposure. The question is: does it add anything new when we combine it with what we know about an individual’s standard risk factors?
In a recent analysis of 14 studies involving over 45,000 men and women, Dr. Hester M. Den Ruijter and associates found that the test did very little to change an individual’s calculated risk for heart disease over 10 years. In their study, published in the August 22, 2012 edition of the Journal of the American Medical Association, less than one percent of people undergoing the test would have their cardiovascular risk status reclassified on the basis of their CIMT. The test was only slightly more effective if just those at intermediate risk were evaluated.
What this means is that the risk factors we can easily and cheaply identify are the most powerful predictors of heart disease and stroke. The CIMT is not harmful, but it it’s not cheap. Typical costs run around $150 to $500, and insurance does not generally cover the test.
The CIMT should not be confused with a carotid Doppler exam. This is a much more detailed ultrasound study of the neck arteries, and is generally performed when a blockage is suspected. When ordered appropriately, it is usually covered by insurance and Medicare.