Calcium Score vs. CIMT vs. ABI: The Faceoff

You know I keep pushing for more CIMTs
and I feel a little bit about like the old Maytag repairman. Nobody’s interested.
Actually, there are a ton of people that are interested… that are looking deeper
at preventive services but here’s part of the reason why I’m going to show one
of the pieces of science out there comparing coronary artery calcium score
and ABI with CIMT. What is ABI (ankle brachial index)? You
take your blood pressure in your arm your break-in and your ankle and you
look at the differences. If there’s a significant amount, the theory is this: if
there’s a significant amount of plaque in between like in the aorta and the
pelvic walls, that’ll decrease the blood pressure getting down to the ankle. And
it does work. As you’ll see in this, it really works more for folks that have
higher risk already. We know they have risk but it’s an acceptable way to follow people and to (again) look at risk.
What did we find here and what was the problem?
Why did CIMT not show up as well? We’ll get to that just a minute. So, “Comparison
of coronary artery calcification, the carotid intima-media thickness and ankle
brachial index for predicting 10-year incidence of cardiovascular events in
the general population.” This was in the European Heart Journal of 2017. They quantified CAC, CIMT, and ABI in
3,100 patients, followed them for about 10 years. It was in a study that was
already existing – the Heinz Nixdorf Recall study that was in the Ruhr
region of Germany. So their read on it is that over the past two decades, there’s
been a growing acceptance of some type of study to help or procedure to help
differentiate risk for people that are at low risk for heart attack and stroke,
at least according to Framingham, and history-based surveys like that. Now we
used to… and you still see tons of it… it used to be accepted to do stress tests.
What’s happened is this, and let me just warn you off of this. One of the more
common assumptions from yeah the healthy worried group is to go to their doctor,
their internist or cardiologists, their family practitioner, and say, “Look, I just
you know I’m I know you tell me I’m in good health but I just like to get a
screening test anyway.” If you are the doc or if the doc suggests a stress test, run
the other way and here’s why. I cannot tell you the number of people that have
something come up on a stress test even though they were healthy. And if you get
something on a stress test, you’re now very worried, the docs worried,
and the only way to figure that out is angiogram. So once you start doing an
angiogram (that’s an invasive study), that results in significant injury, and it has over and over again so and there have actually been studies showing that the probability of somebody
having a problem is much greater if they go get a stress test. If they’re in the
low-risk category so just don’t do it. So they’re still working through the
current guidelines on when to do. Coronary calcium, CIMT, and ABI. There
were changes in ’09 where they started to agree to those… that was
actually one year by the way after the death of the very highly publicized
death of Tim Russert, another one of these guys that fit into this “low
risk” category and who was found after his death upon autopsy to have arteries
that were full of plaque. He had a destroyed… a ruptured plaque
that caused a heart attack. So again for this study, the recent data suggests that
these may not be equally defined at the end of this day. Here’s what they found.
They took German Ruhr residents. They’re already in that Nixdorf study… Nixdorf Recall study. Ages 45 to 74. Ultrasound on the right and left. They
did I just IMT, no mean max and again this just underlined lines that there
are no standards yet. For the CIMT, 3,108 study participants and they had what about 200 I think events
during that ten-year period. So that equals out to a low-risk population
about seven and a half percent events over that 10-year time period. Here was
one of the keys images that they showed in the study and here’s the again what
they did. They just dichotomize. They figured out how can we create a
dichotomy to show the difference between these a positive score and a negative
score. Well again those of you who are familiar with the CIMT, you’re looking
at arterial age or IMT, and you’re looking at risk associated with mean max. In other words the number of high peaks that you have in terms of arterial
plaque, it’s sort of like trying to shoehorn that into their own type of
standard. It did show a difference and actually they admitted later on in the
study that CIMT was maybe a little bit better for the low risk group.
However, at the end of the day, they said, “Let’s use coronary artery calcium score.”
What’s my perspective? I would just be so happy if the insurance company would quit reimbursing stress test for low risk populations and reimburse
all three of these that would at least be such a step forward. Before I turn
this into a rant, I’ll sign off. Thanks for your interest. So you’ve been
asking about it. When’s the CIMT access tour? Starting Anaheim LA September 28th. David Meinz will be there with some with a CIMT tech. It’s about 250 bucks
for the whole afternoon plus the CIMT plus the reading on the CIMT. If you
have further interest, you can sign up at CardioRisk.US/HealthyLife.

8 thoughts on “Calcium Score vs. CIMT vs. ABI: The Faceoff

  • September 13, 2019 at 3:23 pm

    "Our results confirmed that CAC-scoring outperforms CIMT and ABI in its overall predictive ability."

  • September 13, 2019 at 3:23 pm

    Hi Dr. Brewer
    As a scientific researcher, I much appreciate your approach, and for emphasizing the science behind the topics you cover. It may well be that you are part of a paradigmatic shift in how medicine is practiced here in the US.

  • September 13, 2019 at 4:14 pm

    Great study to help us see the value with these tests. Thanks for making this video. Happy to share it.

  • September 13, 2019 at 6:15 pm

    Thank you for this video- great job! Do you have the link to that study? I am interested in those graphs

  • September 13, 2019 at 7:17 pm

    Lifeline Screenings does ABI. Their tests said I did not have peripheral artery disease. Their screening test on the carotid arteries said I only had "mild" plaque. But the coronary artery calcium scoring test came back with a score of 233, a far less rosy picture although that's not a catastrophic result.

  • September 13, 2019 at 7:29 pm

    Here us a good case study for you and your subscribers: I'm 70. Have two knees that need replacing. Dad died of heart attack at age 66. Being treated by cardiologist for 10 years that also doesn't believe in EKG and Stress tests. Hospital required EKG. I failed it. Went and had a stress test- failed it. My Dr. says I am OK, doesn't believe in stress test don't need cath. I talk him into getting me a CT Scan. Scan shows 8700 calcification and blockage in both left and right artery. Dr. say still Ok to do knee surgery, but I don't like the look of the CT Scan. I go get a second opinion from other cardiologist. She says need a cath immediately. So I have a cath reluctantly. She goes in and out again. 100% blockage in right artery and 80% blockage in left artery and more blockage in OM1 and OM2 branch arteries. I am told I need by-pass. I am in shock. I go to another cardiologist, and he looks at the cath CD, and says he can stent but would take several stints and would be riskier than by-pass! Meanwhile my original Dr. is still telling me I am fine until I show signs of heart issues. I feel fine and no pain or breathing problems. So about 5 doctors say I need by-pass soon and one says no I am OK? What do I do? My family and friends are urging me to have the surgery. I have just about decided to go ahead with the by-pass. So in my case, the knee and the tests I had to go through, may have saved my life? I don't know?

  • September 13, 2019 at 9:49 pm

    I now live in the boonies. So i am kinda stuck with CAC tests. But, i will stay tuned in case a CIMT manages to get near me.

  • September 14, 2019 at 6:15 am

    Thanks for the VDO, Dr Brewer, very interesting article. So you would expect a very high inverse correlation between the CAC-score and the Ancle-Bracial-Index, i.e. a high CAC-score would strongly correlate with a low ABI-score. Has there been any studies done on this correlation?


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