When it comes to testing for heart disease, most people imagine huffing and puffing on a treadmill, wired to an EKG.

But these days, early screening for heart disease can be much simpler and more effective.

An inexpensive, painless test known as intima-media thickness, or IMT, is now commonly used to assess the risk of heart attack and stroke.

IMT uses ultrasound to detect atherosclerosis – fatty plaque buildup – in the carotid arteries, which carry blood from the heart to the brain.

Studies show the thickening of carotid arteries predicts heart attacks and stroke at least as well as high cholesterol levels or high blood pressure – sometimes better, says Mills-Peninsula cardiologist Robert Zipkin, M.D.

Traditional risk factors – smoking, hypertension, age, diabetes, elevated cholesterol and family history – help identify those at higher risk for atherosclerosis.

“But many people have only a few risk factors, so doctors sometimes aren’t sure whether they should alter their diets, take medicine, do both or nothing at all,” the doctor said.

“That’s where IMT comes in – it gives doctors and patients information independent of risk factors about their mid- to long-term risk for heart disease and stroke.”

IMT is an outpatient test that takes less than 20 minutes.

“No needles, no drugs, no radiation, no need to undress – just don’t wear anything that hides your neck,” says Dr. Zipkin. “IMT is benign and brief.”

Testing is similar to a pregnancy ultrasound, except the gel and ultrasound camera are placed on the sides of the neck to create an image of the carotid artery walls.

The test shows whether the arterial wall’s thickness is within normal range based on age and gender. The thicker the walls, the higher the risk, and the more aggressive the treatment recommendations, including diet, exercise, other lifestyle changes or medicines. Follow-up testing can be used to track the effectiveness of treatment.

Mills-Peninsula was the first IMT testing center in the region, combining the most experience with the highest quality imaging equipment and digital image processing.

The $150 cost is typically an out-of-pocket expense because most medical insurers currently don’t cover the test. Dr. Zipkin believes that policy will change.

“Many international medical societies recognize the value of IMT. And because of its cost and ease, it comes out ahead of other visual screening tests.”

To view a short video of an IMT test, visit www.mills-peninsula.org/IMT.

3 steps to heart disease detection
As heart disease progresses, it becomes more complicated to manage. But high-tech innovations at Mills-Peninsula make it easier for cardiologists to treat people with various types of risk factors and at all levels of cardiovascular health. Cardiologist Jeffrey Guttas, M.D., describes detection as a three-step method. Learn your risks through a visit to your doctor, who may suggest the following:

1) Screening tools. After cholesterol, blood pressure and blood glucose screening, simple, painless tests like the IMT (described in the story, opposite) are the first noninvasive imaging steps in measuring risk.

2) Non-invasive diagnostic tools. If results are abnormal, it will often lead to a stress echocardiogram test, in which a patient exercises on a treadmill with ultrasound images taken before and immediately after exercise to evaluate for abnormalities in the motion of the heart wall. Stress nuclear tests involve an extra step in which a radioactive substance is injected into the bloodstream to create images of the blood flow in the heart muscle.

3) Operational procedures. If stress test results are positive for coronary disease, the next step to determine is how much. A coronary angiogram uses a catheter to inject dye into the heart’s arteries and search for fatty plaque blocking the blood flow. “By localizing blockages, we can define how to treat it, whether with medicine, an angioplasty stent or, if severe, a bypass,” says Dr. Guttas. Simpler cases can be fixed with a stent immediately following the angiogram, while those with severe symptomatic coronary disease may be recommended for bypass surgery