In the 1600's, the leading physician in England (Thomas Sydenham, MD) wrote that "A man is as old as his arteries". We would now change that to "A person is as old as his or her arteries" but Dr. Sydenham's viewpoint has proven to be accurate and visionary.
At the Kahn Center, patients have extensive lab studies but also have imaging of their carotid arteries using digital imaging (CIMT) and CT imaging of the heart (at least a calcium CT scan or CACS but often a digital AI coronary CT angiogram). If atherosclerosis is identified, at least 50% of patients, a program is instituted to halt and reverse the disease and follow up imaging is scheduled. Does this strategy have academic support? A new and important study says the stategy used at the Kahn Center is the future of cardiology now!
A population of 5,716 asymptomatic U.S. adults (mean age 69 years, 57% female) enrolled between 2008 and 2009 in the BioImage study underwent examination by cartoid ultrasound to quantify carotid plaque burden (cPB) (the sum of right and left carotid plaque areas) and by computed tomography for coronary artery calcium scoring (CACS). Follow-up carotid vascular ultrasound was performed on 732 participants a median of 9 years after the baseline exam. All participants were followed up for all-cause mortality, the primary outcome.
Over a median 12 years’ follow-up, 901 (16%) participants died.
After adjustment for cardiovascular risk factors and background medication, both the baseline carotid ultrasound and CACS score were both significantly associated with all-cause mortality.
The carotid ultrasound performed better than CAC score.
In participants with a second carotid ultrasound evaluation, progression of plaque in the carotid arteries was significantly associated with all-cause mortality after adjusting for cardiovascular risk factors.
This study is very important and supports the way patients are managed at the Kahn Center. Silent and "subclinical" atherosclerosis found in the carotid artery (CIMT) or in the coronary arteries (CACS) in asymptomatic individuals was independently associated with all-cause mortality. Moreover, atherosclerosis progression was independently associated with all-cause mortality.
Unfortunately, current practice patterns recommend cancer screening like mammography and colonoscopy but artery screening is not a routine recommendation though it is the long time pattern at the Kahn Center.
It is time to add carotid and heart screening studies to the routine check up at age 45-50 years and periodically thereafter.
The study did not evaluate the newer coronary CT angiogram with AI interpretation (Cleerly Health), a breakthrough advance that adds precise plaque measurements and plaque characterization.
The future is bright!
