Most of us avoid the gym because it is too much work, yet we all know the health benefits of working out regularly. However, working out is not a precursor to good health. Take for example Bob Harper. You may recognize Harper's name as the celebrity host of the net- work TV show, The Biggest Loser. He was the poster child of great health. He worked out regularly, he ate all the right foods, he saw his doctors regularly and followed their instructions yet why, at age 51 did he have a near life-ending heart attack?

All this happened despite Harper a picture of health and taking a statin for cholesterol, as prescribed by his doctor. Harper carried a protein in his body called lipoprotein(a) or Lp(a). Approximately sixty million Americans have high Lp(a) levels. It is a silent killer. Two out of ten people reading this report right now are at risk of heart attack, atherosclerosis, stroke, aortic valve disease, or heart failure because of high Lp(a) levels specifically. If you take statins to reduce cholesterol, as did Bob Harper, you could be at a higher risk from lipoprotein(a).

Lp(a) is not the only condition to increase one's risk for cardiovascular disease and other heart and health related dangers. Unfortunately, physicians are not able to catch all the threats associated with such "Widow-maker" conditions, like that of Bob Harper.

It's important to note that individuals often have multiple risk factors that can interact and compound their overall risk. Assessing and managing these risk factors through lifestyle modifications, medication, and other interventions (such as a CIMT test) can help reduce the risk of cardiovascular disease and its complications. Additionally, regular medical check-ups and screenings can help identify risk factors early and guide preventive measures.

Myth #1: "I'm in great health - I eat right and exercise regularly."

So did Bob Harper...

Being healthy and eating right plays a significant role in one's overall well- being. However, even individuals who lead healthy lifestyles can still be at risk for cardiovascular disease.

Having a CIMT test performed is not because anything specific is suspected, but rather because it's an opportunity for you to gain further insight into your cardiovascular health. CIMT testing allows you and healthcare providers to assess the health of your carotid arteries, which are important blood vessels in your neck that supply blood to your brain.

While you may feel great and have no symptoms, early signs of arterial disease can sometimes develop silently, without obvious symptoms. By detecting any potential issues early, you have the opportunity to take proactive steps to manage and reduce your risk of cardiovascular events, such as heart attack or stroke, in the future.

Think of it as a preventive measure, much like getting regular check-ups or screenings for other health conditions. It's about staying ahead of any potential problems and maintaining your long-term health and well-being.

Ultimately, the decision to undergo the CIMT test is yours. It could provide valuable information that can help you to continue to prioritize your health and well-being.

Myth #2: "If my doctor thought I needed a CIMT test, he/she would have suggested it."

It's understandable to assume that if a CIMT test were necessary, your doctor would have suggested it. However, it's important to recognize that healthcare providers may have different approaches to preventive care and may prioritize certain tests or screenings based on their training, experience, clinical judgment, and outside influences, such as that of insurance companies.

The decision to get a CIMT test is influenced by many factors, including your individual risk factors, medical history, and your specific goals for your overall health. While your doctor may not have suggested a CIMT test previously, it doesn't necessarily mean that it wouldn't be beneficial for you. Unfortunately, insurance providers require today's physicians to see more patients while also dictating how much time a doctor may spend with and on a patient. A CIMT test will help your doctor help you. In the end, you know either way; if you are at risk or you are not.

Myth #3: "Cardiac threats will be detected on other tests my doctor runs."

While certain tests and screenings may detect some cardiac threats, not all potential cardiac issues may be identified through routine tests alone. Some cardiac threats, such as early signs of atherosclerosis or subtle changes in the carotid arteries, may not be detected by standard tests like blood pressure measurements or cholesterol screenings.

Carotid Intima-Media Thickness (CIMT) testing, for example, can provide additional information about the health of the carotid arteries and the presence of early atherosclerosis, which may not be captured by routine blood tests. Similarly, imaging tests like coronary calcium scoring or cardiac CT angiography can help identify calcified plaque in the coronary arteries, which is a marker of coronary artery disease (CAD) and an increased risk of heart attack.

Additionally, not all cardiac threats present with obvious symptoms, especially in the early stages. Some individuals may have silent or asymptomatic cardiovascular disease, meaning they have underlying heart or vascular problems without experiencing noticeable symptoms. Specialized tests and screenings may be needed to detect these silent threats and provide early intervention to reduce the risk of cardiovascular events.

Ultimately, the specific tests recommended by your doctor will depend on your individual risk factors, medical history, and clinical presentation. It's important to discuss your concerns and healthcare needs with your doctor to ensure appropriate screenings and diagnostic tests are performed to evaluate your cardiac health comprehensively.

Myth #4: "Plaque of the arteries is different than plaque on my teeth"

While artery plaque and dental plaque are different substances that form in different parts of the body, there are some connections between oral health and cardiovascular health. Some research suggests that the bacteria and inflammation associated with periodontal (gum) disease may contribute to the development or progression of atherosclerosis and cardiovascular disease.

While artery plaque and dental plaque are distinct entities, studies have found associations between periodontal (gum) disease and an increased risk of cardiovascular disease, suggesting that the bacteria and inflammation associated with gum disease may contribute to the development or progression of atherosclerosis and cardiovascular events.

Myth #5: "I take medication for high blood pressure, statins for cholesterol. I'm good!"

Blood pressure-lowering medications and statins can effectively lower blood pressure and cholesterol levels, respectively, which are key risk factors for cardiovascular disease. By doing so, these medications can slow the progression of atherosclerosis, stabilize plaque, and reduce the risk of cardiovascular events. However, they do not completely eliminate the underlying plaque or reverse the existing damage in the arteries. However, atherosclerosis and cardiovascular disease are multifactorial conditions influenced by a variety of risk factors beyond blood pressure and cholesterol levels.

Additionally, medication adherence plays a crucial role in achieving optimal outcomes, and individuals may not always take their medications as prescribed. Lifestyle factors, including diet, physical activity, stress management, and tobacco use, also play a significant role in cardiovascular health. While medications can help manage specific risk factors, lifestyle modifications are essential for achieving comprehensive cardiovascular risk reduction.

Carotid intima-media thickness (CIMT) is a measurement used to assess the thickness of the carotid artery's walls. This measurement is specifically of two layers of the carotid artery: the intima and the media. The carotid arteries are major blood vessels in the neck that supply blood to the brain. The thickness of these layers can be an indicator of atherosclerosis, a condition characterized by the buildup of fats, cholesterol, and other substances in and on the artery walls (plaque), which can restrict blood flow.

CIMT is measured using ultrasound imaging. The test is non-invasive and can help in the early detection of cardiovascular disease. An increased CIMT is associated with a higher risk of heart attacks and strokes, even in the absence of other traditional cardiovascular risk factors. Thus, CIMT can be used as a marker for cardiovascular disease risk assessment, allowing for early intervention strategies to prevent more serious cardiovascular events.

The device used to perform the test and the images it produces are similar to that used and seen for an ultrasound performed on expecting mothers. Unlike prenatal ultrasound equipment, the CIMT device is handheld.

Carotid Intima-Media Thickness (CIMT) testing may be considered for individuals who are at increased risk of cardiovascular disease or stroke. While specific recommendations may vary depending on individual risk factors and medical history, it is a test everyone should consider having done.

Take the following self-assessment test to indicate your risk factor for atherosclerosis and weather having a CIMT test would be prudent:

1. Age

• Are you 40 years old or older? (Yes/No)

2. Blood Pressure:

• Do you have high blood pressure (hypertension), or are you currently taking medication to lower your blood pressure? (Yes/No)

3. Cholesterol Levels:

• Have you been diagnosed with high cholesterol (hyperlipidemia), or are you currently taking medication to lower your cholesterol levels? (Yes/No)

4. Diabetes

• Have you been diagnosed with diabetes mellitus (Type 1 or Type 2)? (Yes/ No)

5.5Obesity/Chronic Obesity:

• Normal weight: BMI 18.5-24.9
• Overweight: BMI 25-29.9
• Obesity:
1. Class I: BMI 30-34.9
2. Class II: BMI 35-39.9:
3. Class III (severe obesity): BMI 40 or greater:

6. Lifestyle Factors:

• Do you smoke or have a history of smoking? (Yes/No)
• Do you engage in regular physical activity (at least 30 minutes of moderate exercise most days of the week)? (Yes/No)
• Do you have a healthy diet that includes a regular diet (3-4 times a week) fruits, vegetables, whole grains, and lean proteins, and limits saturated fats, trans fats, cholesterol, sodium, and added sugars? (Yes/No)

Scoring:

• Each "Yes" response counts as 1 point
• Add up your points to determine your risk level:
• 0-2 points: Low risk
• 3-4 points: Moderate risk
• 5-6 points: High risk

Whether Carotid Intima-Media Thickness (CIMT) testing is covered by insurance depends on several factors, including your insurance provider, your specific insurance plan, the reason for the test, and any medical necessity criteria that apply. The investment for having the test done is minimal, making it affordable as an out-of-pocket expense, if your insurance does not cover it. It is, however, an important baseline test for one's risk factors. You can check with your medical insurance provider to see if your policy reimburses you for the test.

Like any diagnostic test, CIMT testing is not perfect and may produce false positive or false negative results. False positives may lead to unnecessary anxiety or additional testing, while false negatives may provide a false sense of security. This is why the results of the test are read and interpreted by a licensed radiologist.

1. Inform the Healthcare Provider: Make sure to inform the healthcare provider performing the test about any medications you are currently taking, especially blood thinners or medications that affect blood pressure.

2. Avoid Caffeine and Tobacco: It's typically recommended to avoid caffeine and tobacco products for several hours before the test, as these substances can temporarily affect blood pressure and heart rate, potentially impacting the results.

3. Wear Comfortable Clothing: The test is performed on your neck between your head and shoulders. You should wear a shirt allowing access to your neck. Also, do not wear any neck jewelry during the test.

4. Relax and Stay Calm: Stress and anxiety can affect blood pressure and heart rate, so it's important to try to relax before and during the test. If you have any concerns or questions about the procedure, don't hesitate to discuss them with your healthcare provider beforehand.

The relationship between Carotid Intima-Media Thickness (CIMT) and dentistry primarily revolves around the link between periodontal disease (gum disease) and cardiovascular diseases. Research has suggested a connection between oral health, specifically periodontal disease, and increased risk of heart disease. Here's how CIMT ties into this relationship:

1. Periodontal Disease and Systemic Inflammation**: Periodontal disease is a chronic inflammatory condition that affects the gums and bone supporting the teeth. It is caused by bacterial infections that, if untreated, can lead to tooth loss. More importantly, the inflammation associated with periodontal disease doesn't stay localized to the mouth; it can contribute to systemic inflammation, which is a risk factor for atherosclerosis, the buildup of plaque in the arteries that can lead to heart disease and stroke.

2. Atherosclerosis and CIMT**: Atherosclerosis involves the accumulation of plaques within the walls of arteries, leading to thickening and loss of elasticity of the arterial walls. CIMT measurement is a method used to detect the early stages of atherosclerosis by measuring the thickness of the carotid artery walls. An increased CIMT is considered a marker of atherosclerosis and, thus, an indicator of an elevated risk for cardiovascular diseases.

3. Link Between Oral Health and CIMT**: Some studies have shown that individuals with periodontal disease may have increased CIMT compared to those without periodontal disease. This suggests that periodontal disease might be a risk factor for the development of atherosclerosis and, consequently, cardiovascular diseases. The hypothesis is that the systemic inflammation and bacteria associated with periodontal disease might contribute to the thickening of the artery walls.

4. Dentistry's Role**: Dentists play a critical role in identifying patients with periodontal disease and providing treatment to control infection and inflammation. By managing periodontal disease effectively, dentists may help reduce systemic inflammation and potentially decrease the risk of cardiovascular diseases. Furthermore, recognizing the connection between oral health and cardiovascular health allows dentists to collaborate with medical healthcare providers to ensure a holistic approach to patient care.

The relationship between CIMT and dentistry highlights the importance of oral health in overall health and underscores the need for interdisciplinary approaches to patient care that consider the links between periodontal disease and cardiovascular diseases.

At Family Dental Care of Oak Park, our approach goes beyond traditional dental care. We prioritize not only your dental health but also your overall well-being. Our practice emphasizes an oral/systemic approach to care and treatment, recognizing the mouth as the gateway to the body. With over six hundred different bacteria active in the mouth, many of which can affect the body, we believe in addressing oral health in conjunction with systemic health.

Dr. Scapillato leads the way as the first dentist in the area to advocate for and implement oral/systemic care for our patients. We are dedicated to providing comprehensive care that considers the interconnectedness of oral health and overall health.

Dr. Scapillato stands out as the sole dentist in Chicago with the capability to perform CIMT tests, having received specialized training for this purpose. In collaboration with a licensed radiologist, all scans are meticulously submitted for expert reading and assessment.