carotid

Preventing thousands of strokes per year through quick carotid ultrasound screening

/ William Driscoll / Leave a comment

Screening all Americans aged 65 and older with a quick, one-minute carotid ultrasound test could help prevent thousands of strokes per year, says an article published in the Annals of Translational Medicine.

The authors say that a one-minute ultrasound screening test can flag those suspected of having plaque in their carotid arteries causing at least 50% blockage. The carotid arteries carry blood to the brain, and if there is plaque in those arteries and the plaque ruptures, a stroke can result.

Read the free book on “bad” LDL cholesterol, healthy diets, statin safety, and ultrasound artery screening, at the home page: YourArteries.net

For those whose screening test indicates possible substantial blockage, a follow-up “formal” duplex ultrasound test can identify those who indeed have 50% blockage of one or both carotid arteries, the authors say. Those individuals could then protect their arteries and stabilize the plaque, the authors say, by electing either vascular surgery or best medical treatment, with the latter presumably including statin therapy.

A quick carotid scan has been used for many years, the authors say, to screen military retirees at the Madigan Army Medical Center in Tacoma, Washington, and has also been used at New York University.

The authors estimate that their proposed screening and follow-up process would find the estimated 8% of Americans aged 65 and older who, according to their research, have carotid artery blockage of at least 50%. These individuals typically would have had no symptoms, and thus no idea that their arteries were partially blocked. Subsequent treatment could reduce the 5-year risk of stroke for these individuals from 20% if left untreated, to less than 3%, they say.

That would prevent 200,000 strokes and yield one-time Medicare savings of $13 billion from avoided direct medical costs, according to earlier research the article cites, which was led by the same principal investigator.

The authors note that stroke is also the leading long-term Medicare expenditure, “fills one-half of nursing homes,” and “has persisted without reduction for decades,” even though the Centers for Disease Control and Prevention says that 80% of strokes could be prevented.

While Medicare in the U.S. does not cover the cost of carotid screening, “it does reimburse for the further evaluation and management of disease found on screening,” the authors say, “which can cover the nominal monetary outlay of a medical facility to provide the initial screening.”

The authors add that at the time of a quick carotid scan, “there is the option of including an ultrasound scan of the abdominal aorta to discover aortic aneurysms prior to rupture, and of scanning the common femoral artery to identify arteriosclerotic plaques which have a high correlation with coronary artery disease and can be a trigger for a cardiac and metabolic evaluation.”

The study, available online for free, is titled “The quick carotid scan for prevention of strokes due to carotid artery disease.”

Early-stage artery clogging slows down your brain; statins can help

/ William Driscoll / Leave a comment

Artery clogging not only causes heart attacks and strokes, but also slows down your brain, according to a study published in the Journal of the American College of Cardiology.

Fortunately, you can get tested for artery clogging, even without a doctor’s order, and if your arteries are getting clogged, a statin drug can slow, stop, or even reverse the process.

Read the free book on “bad” LDL cholesterol, healthy diets, statin safety, and ultrasound artery screening, at the home page: YourArteries.net

The study’s authors evaluated participants who had early-stage plaque in their carotid arteries, which carry blood to the brain. These individuals were found to have “reduced brain metabolism” relative to participants with unclogged arteries. Areas of the brain showing reduced metabolism included areas “known to be affected in dementia.”

The authors pointed to “the need to control cardiovascular risk factors early in life in order to reduce the brain’s midlife vulnerability to future cognitive dysfunction.”

The good news for now is that if you’re middle-aged or older you can obtain, with or without a doctor’s order, a carotid artery ultrasound test to identify the presence or extent of clogging in your carotid arteries.

And if that test shows that the carotid arteries are clogged, a preventive cardiologist can prescribe statins at a dose high enough to aggressively lower your level of “bad” LDL cholesterol, which is a major component of the plaques that clog arteries. A daily statin pill at the right dose can not only protect the brain but can also stabilize the arterial plaques throughout the body, or even shrink existing plaques, lowering the chance of a heart attack or stroke.

The study, available free online, is titled “Subclinical Atherosclerosis and Brain Metabolism in Middle-Aged Individuals: The PESA Study.” Atherosclerosis is the medical term for artery clogging.

High blood pressure above 130/80 is a good reason to get checked for artery clogging

/ William Driscoll / Leave a comment

By William L. Driscoll

Even a mild form of high blood pressure—where the first number is from 130-139, or the second number is from 80-89—is a strong predictor of artery clogging, as reported in a scientific journal article in the American Journal of Hypertension.[1] At blood pressure readings above those levels, researchers found that the prevalence and burden of artery clogging increased.

Overall, the contribution of high blood pressure to artery clogging has been “intensively studied” and is “well understood,” says a scientific journal article published in the journal ­­­­­Cells.[2]

So a doctor could tell someone with elevated blood pressure that their arteries may be getting clogged, that artery clogging increases their risk of a heart attack or stroke, and that there are good options to screen for artery clogging, and to treat it, if found.

Unfortunately, many doctors don’t say that. So if you or someone you know has been diagnosed with high blood pressure, here’s what you should know.

Read the free book on “bad” LDL cholesterol, healthy diets, statin safety, and ultrasound artery screening, at the home page: YourArteries.net

Screening can tell anyone whether they have artery clogging that has reached a concerning level. If so, they may then find a preventive cardiologist, who can help them slow or stop the progression of artery clogging through aggressive lowering of LDL (bad) cholesterol.

Ultrasound screening of the carotid arteries can indicate the extent of artery clogging throughout the body. The ultrasound test is just like the one used for pregnant women, but is performed on the neck, where the carotid arteries are, instead of the belly.

Regrettably, carotid ultrasound screening is not yet routinely available to patients at their doctor’s office. Some doctors and traditional cardiologists may be willing to order a carotid ultrasound test on the basis of a high blood pressure reading, particularly if that reading is fairly high.

Alternatively, people over 50 can obtain such screening from the company Life Line Screening, which offers a rapid form of carotid artery ultrasound screening.

The results of such rapid testing may be helpful in securing an appointment with a preventive cardiologist. Even if the results indicate carotid artery blockage of less than 50%, a preventive cardiologist may offer an appointment, because artery clogging can advance rapidly,[3] and preventive cardiologists aim to prevent further artery clogging. During an appointment, a preventive cardiologist might decide to order a “gold standard” carotid artery screening test, which provides more information but takes a bit longer, and therefore costs more.

In the future, carotid artery ultrasound tests may be available from your regular doctor, as part of a routine physical, using a low-cost handheld ultrasound device made by GE, Philips, or Butterfly Network.

[1] https://academic.oup.com/ajh/article/33/1/92/5552456

[2] https://www.mdpi.com/2073-4409/9/1/50

[3] https://www.jacc.org/doi/10.1016/j.jacc.2020.02.026

Carotid artery screening can save lives, so USPSTF, please revisit your analysis

/ William Driscoll / Leave a comment

By William L. Driscoll

Carotid artery screening that can identify early-stage artery-clogging is becoming far less expensive, thanks to new handheld ultrasound devices used for screening.

In a review of carotid artery screening, the U.S. Preventive Services Task Force made a compelling argument in favor of such screening, in a recommendation early this year.

The task force said that plaque in the carotid arteries, known to doctors as atherosclerosis, “is a manifestation of systemic atherosclerotic disease, so identifying this condition may potentially lead to changes in medical management to prevent future cardiovascular events,” such as heart attacks and strokes.

Read the free book on “bad” LDL cholesterol, healthy diets, statin safety, and ultrasound artery screening, at the home page: YourArteries.net

Regrettably, although the USPSTF saw that carotid artery screening could save lives, by helping prevent heart attacks and strokes, it advised against widespread carotid artery screening. That’s because preventing deaths through changes in medical management, such as statin therapy, was “outside the scope” of its review, the USPSTF said.

It’s time for the USPSTF to take another look, as many in the medical community trust its recommendations. Costs for ultrasound carotid artery screening have come down, thanks to new handheld ultrasound devices from GE, Philips and Butterfly Network. Meanwhile, more patients with early signs of artery-clogging are turning to preventive cardiologists to help them aggressively lower their LDL (bad) cholesterol to stop further artery-clogging, or even reverse it, and so prevent heart attacks and strokes.

The U.S. Preventive Services Task Force is an independent, volunteer panel of 16 national experts in disease prevention and evidence-based medicine. Task force members are appointed to four-year terms by the Director of the Agency for Healthcare Research and Quality, within the U.S. Department of Health and Human Services.

The current USPSTF recommendation is titled “Asymptomatic Carotid Artery Stenosis: Screening.”