Once again during February (“heart month”), Compass Peak Imaging in Glenwood (970-665-2194) is offering a special price for carotid IMT heart disease screening — a special, FDA-approved ultrasound study that assesses artery health.

Heart attacks are the number one cause of death in the U.S. year after year, in spite of essentially all of them being preventable. Here’s what Christiaan Barnard — the South African heart surgeon who performed the first heart transplant — had to say about heart attack prevention: “I have saved the lives of 150 people by heart transplants. If I had focused on preventive medicine earlier, I might have saved 150 million.”

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Unfortunately, medical training and practice in the U.S. are geared towards managing chronic diseases such as heart disease with pills and procedures instead of preventing them. Heart disease is looked at as a plumbing problem, with blockages that need to be fixed with stents and bypass procedures, rather than a medical disease (atherosclerosis — hardening of the arteries) that can be prevented, treated and reversed through simple lifestyle changes and, when necessary, non-invasive medical therapy.

About 50% of men and 70% of women who die suddenly from heart disease had no prior symptoms, making screening for diseased arteries imperative.

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Risk factors for atherosclerosis/heart attacks include: smoking; blood pressure above 120/80; high total cholesterol, low good cholesterol (HDL), high LDL (bad cholesterol), high triglycerides; obesity, particularly around the waistline; pre-diabetes and diabetes; sleep apnea; inflammation including that due to dental disease; sedentary lifestyle; stress including depression; inadequate sleep; the standard American diet; age (men over 40, women over 50); family history of cardiovascular disease; gout; autoimmune disease; erectile dysfunction; migraine headaches; and sleep apnea.

Some doctors use risk calculators based on these risk factors, but as respected heart attack prevention experts Bale and Doneen point out in their 2022 book “Healthy Heart, Healthy Brain,” these risk calculators are dangerously inaccurate.

If arteries are stressed by bad genes; bad habits such as smoking or unhealthy eating; or by other aforementioned risk factors, the endothelium that lines arteries thickens, and eventually plaque (atherosclerosis) develops — 99% of which is in the walls of the arteries, not causing a blockage. If the plaque ruptures — often triggered by inflammation — a blood clot forms in the artery, blocking the blood flow, causing death of part of the heart muscle (or brain in the case of a stroke).

Twenty percent of heart attacks result in sudden death. For the other 80% of heart attack victims who make it to the hospital, an interventional cardiologist can save lives by opening the blockage with a stent. However, stents and bypass procedures don’t treat the underlying disease, and in non-heart attack settings have not been shown to save lives or improve quality of life.

There are two commonly-used methods of determining arterial health. One is coronary calcium scoring, available at most imaging centers. This is a CT scan of your heart, which shows how much calcium (atherosclerosis) you have in your coronary arteries. It involves a small amount of radiation, and can result in false-negatives because it doesn’t pick up non-calcified plaque, which is the most dangerous kind. Repeat coronary calcium scoring is not useful in determining effectiveness of treatment, because calcification of uncalcified plaque — which is a good thing — results in a higher score.

The second method is carotid IMT, which provides a soundwave picture of the carotid arteries, located just beneath the skin on both sides of the windpipe, and therefore easily assessable. It measures the thickness of the endothelial lining, and picks up both calcified and uncalcified plaque. If abnormal, IMT should be repeated a year after starting treatment — appropriate treatment should result in less endothelial thickening, stable or lesser amount of plaque, and calcification (stabilization) of uncalcified plaque. The downside of IMT is that it looks at the carotid rather than the coronary (heart) arteries, but there is a 95% correlation between the two — i.e. if you have atherosclerosis in one area you almost certainly have it in arteries throughout your body.

The Bale-Doneen Method is one of the most successful heart attack prevention methods in the U.S. Dr. Doneen recently served on a Society of Atherosclerosis Imaging and Prevention expert committee, which developed guidelines for IMT screening. They recommend carotid IMT screening on everyone at age 40, and younger if significant risk factors are present. Note that the carotid IMT is much more sensitive than the usual carotid ultrasound done at most imaging centers and by companies such as Lifeline Screening — which just pick up major blockages.

Next week’s column will be about what to do if you are found to have plaque.

Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market, and cooking classes. Call 970-379-5718 for appointment, or email gfeinsinger@comcast.net.