Carotid Artery Ultrasounds (CIMT) and Heart Health

Patients ask me all the time what they can do about their high cholesterol, or whether they should even be worried about it in the first place. It’s an understandable question – cardiovascular disease continues to be the leading cause of death for men and women in the U.S. To further complicate matters, research on cholesterol is conflicting, with some studies challenging that it’s not the villain it’s made out to be.

Like most things in health (and in life), this is not a simple black and white matter. There is nuance within the cholesterol conversation that helps bring a fuller picture into focus. That said, I wanted to take a moment to layout the screenings I use to assess cardiovascular risk in patients, whether or not they have “high” cholesterol, and introduce a new Carotid Ultrasound (CIMT) screening that we’ve brought to our patients at Northwest Life Medicine Clinic.

Below are some of the methods we use to assess cardiovascular health:

Blood Screening:

Cholesterol Markers
There are many types of cholesterol, not all trigger inflammation, so looking at the broad spectrum gives us a bigger picture. 

• Total Cholesterol

• HDL Cholesterol: Commonly referred to as "good cholesterol."

• LDL Cholesterol: Commonly referred to as "bad cholesterol."

• TC/HDL Ratio: measures the ratio of total cholesterol to HDL cholesterol, which helps assess risk of heart disease. The lower this number, the better.

• Lipoprotein (a): this is a type of genetically driven cholesterol that tends to promote inflammation within the blood vessels. The lower this number, the better.

• Apolipoprotein B: measures the exact amount of pro-inflammatory lipids in the blood. This is a stronger, more direct measurement of “bad cholesterol” than just LDL.

• Lipid Particle Size: when lipids are small and dense, they cause more inflammation in the blood vessels. We want large, buoyant lipids. This panel tells us the size and structure of your lipids.

Inflammation Markers
Cardiovascular disease is driven by blood vessel inflammation. If inflammation is not present, the risk goes down significantly.

• HS-CRP: an inflammatory marker that is more specific to the cardiovascular system.

• Ferritin: stores iron, but when exceptionally high, it is also an inflammation marker.

• Homocysteine: looks at how well the body methylates (activates) vitamins B12 and folate, but very high levels indicate vascular inflammation.

Blood Sugar Markers
Elevated blood sugar and insulin resistance are strong amplifiers of cardiovascular inflammation. We can’t accurately address vascular health without also addressing glucose and insulin metabolism.

• Fasting Glucose: a snapshot of where glucose levels are at when fasting.

• Hemoglobin A1c: shows us the average blood sugar over the past 3 months.

• Fasting Insulin: insulin tells cells to take in glucose from the blood stream. If fasting insulin is high, it could mean those cells are not responding efficiently to insulin and more is being released by the pancreas in response. We call this insulin resistance, and it’s a big driver for inflammation.

• Fasting C-Peptide: this is a precursor to insulin that is more stable outside the body than insulin. I use this as a secondary measurement to assess insulin resistance.

• Triglycerides: this is included in a standard cholesterol panel, however, results are relate to how the body processes glucose. If there’s too much glucose/carbohydrates in the diet or if there is insulin resistance, the liver turns excess glucose into triglycerides. Excess triglycerides increase vascular inflammation.

Complimentary Markers
These help give us a full picture of why lipids might be out of balance.

• Thyroid Markers (TSH, free T3, Free T4 at a minimum): hypothyroidism triggers high cholesterol.

• Liver Markers (AST, ALT, GGT): the liver processes cholesterol, if there is “congestion” in the liver, marked by higher liver enzymes, cholesterol processing is slowed and higher blood levels result.

• Omega 3 Fatty Acids: these are anti-inflammatory and help with lipid and cholesterol metabolism. They are commonly low and play an important role in cardiovascular health.

• Vitamins B12 and Folate: important for many functions in the body, but in this context, they help assess underlying cause if homocysteine is high. Low B12/folate can lead to mildly elevated homocysteine.

• RBC Magnesium: magnesium is important for cardiovascular health, and many folks don’t get enough of it in their diet.

• Iron: ferritin can be high from too much iron, and this level helps assess why ferritin levels may be elevated.

• Estrogen (particularly in women): estrogen helps reduce vascular inflammation and helps to balance HDL and LDL levels. Studies have shown that supporting estrogen in perimenopause and early menopause has long lasting impacts on aging cardiovascular health.

In addition to blood screenings, there are two imaging screenings that I’ll often recommend to assess cardiovascular health:

Imaging Screening:

• Coronary Calcium Score: A CT scan of the heart to look for calcified plaque round the arteries of the heart.  The higher the score, the more likely of a cardiovascular event.

• Carotid Ultrasound (CIMT): A non-invasive ultrasound over both carotid arteries in your neck to measure the thickness (CIMT) of the arteries as well as the size and type of plaque in the arteries.  The CIMT is essentially a measurement of inflammation in the arteries that we can structure our treatment plan around and watch over the course of 6-12 months to look for improvements.  The type of plaque equates to the level of risk of stroke or heart attack.  Homogeneous plaque is the least stable and more prone to rupture and increases stroke or heart attack risk.  Heterogeneous plaque is in the process of stabilizing and echogenic plaque is mineralized, stable plaque.  An additional fun marker on our CIMT reports is your vascular age which is based on the inflammation/thickness in the blood vessels.

The fine print:

• If you are not a current patient with one of our naturopathic doctors, we’ll need a referral from your provider for CIMT screening. We’ll send the results to you and your provider.

• Insurance does not yet cover CIMT screening.

Give our clinic a call to schedule your CIMT scan.