Posted by - J. Rand Baggesen, M.D.

In our continued investigation on preventable health issues this month’s column will investigate the latest technology in regard to early diagnosis of coronary artery disease.

As the baby boom generation continues to age and enter this critical time of their lives, vascular disease and its complications becomes more and more important. Advances in medical technology now give doctors the opportunity to look inside the body and see disease processes years before they might cause a problem like heart attack or stroke.

But it’s often up to the patient to take advantage of some of these advances.

The SHAPE (Screening for Heart Attack Prevention and Education) task force has recently released new guidelines for cardiovascular screening in asymptomatic at risk populations. In summary these new SHAPE guidelines change the paradigm of the American medical system. Typically, our investment in preventative care has been minimal while our medical expenditures to fix a problem once a crisis have been limitless. The new SHAPE task force recommendations are an attempt to reverse that process and invest in early detection and treatment of those at risk.

The screening guidelines for early stage asymptomatic cancers have become the model for early detection of cardiovascular disease (eg, heart attack and stroke). This widely accepted approach calls for noninvasive screening of all asymptomatic men 45-75 years of age and asymptomatic women 55-75 years of age to detect and treat those with sub clinical atherosclerosis. A variety of screening tests are available although there cost-effectiveness in a comprehensive strategy must yet be validated for our population as a whole. That said, various tests including carotid artery intima-medial thickness measurement and measurement of coronary artery calcification by computed tomography scanning provide prognostic information of proven value regarding the future risk of heart attack and stroke. Careful and responsible implementation of these tests as part of a comprehensive risk assessment and reduction approach must be individually tailored for each patient.

Vascular disease/coronary artery disease is a process that begins in the wall of the vessel. Only after years of advanced disease do vessels actually clog up. Many heart attacks occur when the plaque in the vessel wall cracks or breaks off causing an acute blood clot inside the vessel disrupting blood flow down stream causing a heart attack or stroke.

Carotid artery intima-medial thickness measurement (CIMT) is currently the only noninvasive modality recommended by the American Heart Association for use at cardiovascular risk assessment. In use for over 17 years, CIMT uses B-mode ultrasound imaging. This is the same ultrasound technology used to look at unborn babies. CIMT measures the distance between the innermost artery wall and the muscular layers of the outside arterial wall. This is where cholesterol collects and is visible by ultrasound imaging. This test for a patient is easy, comfortable, and repeatable and does not expose you to any radiation. It has been used in multiple drug trials to measure the progression of clinical atherosclerosis, and can show whether treatment can reverse known disease.

Coronary calcium measurement by EBCT coronary calcium scanning can also provide direct evidence of the presence and extent of atherosclerosis. The EBCT calcium score has been shown to correlate strongly with the number of arterial segments showing > 20% occlusion. EBCT scanning is an effective tool to look for hardened/calcified coronary plaque. It does not identify the presence of soft/noncalcified coronary plaque.

High resolution multislice CT Angiography is the latest weapon to identify the presence of vascular disease. Using this technology, it is now possible to do noninvasive cardiac angiography. Angiography looks within the vessel carrying blood to the heart. This test also looks within the wall of the vessel, identifying both soft/noncalcified cholesterol plaques and hard/calcified cholesterol plaques. It has about 5 to 10 times the focus power of the previous generation CT machines used to do coronary calcium scanning.

At the Executive Health Evaluation program at CJW’s Levinson Heart Hospital our goal is to provide the finest medical care using the latest medical technology for our patients. We believe this approach will add years of wellness to our patients who choose to invest in the most important asset they have–their health.

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