Abstract
Objective: Carotid Intima-Media Thickness (CIMT) is an independent risk factor for sub-clinical atherosclerosis. Despite evidence to support its use, CIMT is not currently reimbursed by the Ontario government payment plan. We accessed CIMT in a cohort of patients who chose to pay for the test. The objective is to see if CIMT will add predictive value to traditional risk assessment in this contemporary Canadian cohort. Design and method: We analyzed the first sequential 1,969 patients in a private pay clinic with CIMT from 19 December 2013-29 October 2014. CIMT values were calculated using a Panasonic Healthcare Co. CardioHealth Station bilateral B-mode ultrasound and compared to traditional Framingham Risk Scores (FRS). The CIMT measures considered were mean intima-media thickness (both left and right side) and risk percentiles (low<25%; medium 25–75%; high>75%). The CIMT risk percentiles are based on the original Carotid Atherosclerosis Progression Study (CAPS) database. Results: Of the 1,969 patients, 995 (51%) were classified as low risk, 579 (29%) were classified as moderate risk, and 395 (20%) were classified as high risk for future CV events based on CIMT data. We compared traditional FRS with CIMT results. FRS was only available for 288 of the high CIMT patients (73%). Of these 288 patients, 139 (48%) were considered low risk by traditional FRS. Of the 139 patients who were misclassified by Framingham's (low FRS, high CIMT) 30% of the patients were women; the average age in this group of patients was 51. Ongoing, multi-variant analysis is under way to look for predictors of CIMT values.Conclusions: In a contemporary Canadian cohort FRS has limitations in classifying cardio-vascular disease risk. This was seen in a relatively young population, many of whom were women. Consideration should be given to adopting more widespread use of CIMT screening. This has implications for patient management and funding of such preventive strategies.
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