{"product_id":"coronary-calcium-isnt-the-only-answer-why-carotid-artery-ultrasound-deserves-a-second-look","title":"Coronary Calcium Isn't the Only Answer: Why Carotid Artery Ultrasound Deserves a Second Look","description":"\u003cp\u003eIn a 2019 correspondence published in the journal \u003cem\u003eAtherosclerosis\u003c\/em\u003e, Dr. J. David Spence argues that while coronary calcium scoring is a powerful tool for predicting heart attack and stroke risk, it is not the only—or always the best—option. He points out that ultrasound measurement of carotid plaque burden (plaque in the neck arteries) is less expensive and avoids the cumulative radiation risks associated with repeated coronary calcium scans. Drawing on data from the Multi-Ethnic Study of Atherosclerosis (MESA) and other large studies, Spence makes a case for incorporating carotid ultrasound into routine cardiovascular risk assessment, especially for patients who may need repeated imaging over time.\u003c\/p\u003e\n\n\u003ch1\u003eCoronary Calcium Isn't the Only Answer: Why Carotid Artery Ultrasound Deserves a Second Look\u003c\/h1\u003e\n\n\u003ch2\u003eTable of Contents\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\u003ca href=\"#ddn-key-points\"\u003eKey Points\u003c\/a\u003e\u003c\/li\u003e\n\n  \u003cli\u003e\u003ca href=\"#background\"\u003eWhy Accurate Heart Risk Assessment Matters\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#mesa-study\"\u003eThe MESA Study: A Major Research Effort\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#tests\"\u003eUnderstanding the Tests: Coronary Calcium, IMT, ABI, and Carotid Plaque\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#key-findings\"\u003eKey Findings: What the MESA Study Showed\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#radiation\"\u003eThe Hidden Cost of Coronary Calcium Scans: Radiation Exposure\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#carotid-ultrasound\"\u003eWhy Carotid Plaque Ultrasound Deserves More Attention\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#evidence\"\u003eWhat Other Research Says About Carotid Plaque Measurement\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#implications\"\u003eClinical Implications: What This Means for Patients and Doctors\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#limitations\"\u003eLimitations of This Correspondence\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#recommendations\"\u003eRecommendations for Patients\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#ddn-faq\"\u003eFrequently Asked Questions\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#source\"\u003eSource Information\u003c\/a\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003c!-- ddn:keypoints:start --\u003e\n\u003ch2 id=\"ddn-key-points\"\u003eKey Points\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003eCarotid plaque ultrasound is cheaper and radiation-free compared to coronary calcium CT scans.\u003c\/li\u003e\n\u003cli\u003eCoronary calcium scoring predicts risk well, but carotid plaque burden may add comparable value.\u003c\/li\u003e\n\u003cli\u003eThe MESA study did not directly compare coronary calcium with carotid plaque burden.\u003c\/li\u003e\n\u003cli\u003eThe Tromsø Study found carotid plaque area strongly predicts first-ever ischemic stroke.\u003c\/li\u003e\n\u003cli\u003eDirect imaging of plaque in your arteries can refine risk beyond traditional risk calculators.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003c!-- ddn:keypoints:end --\u003e\n\n\n\u003ch2 id=\"background\"\u003eWhy Accurate Heart Risk Assessment Matters\u003c\/h2\u003e\n\u003cp\u003eEvery year, millions of people worldwide experience heart attacks and strokes, often with little warning. For decades, doctors have relied on risk calculators that combine factors like age, blood pressure, cholesterol levels, smoking status, and diabetes to estimate a person's chance of having a cardiovascular event. These calculations—often called \"panels of risk factors\"—are useful, but they have an important limitation: they estimate risk based on population averages rather than directly looking at whether a person actually has plaque buildup (atherosclerosis) in their arteries.\u003c\/p\u003e\n\u003cp\u003eAtherosclerosis is the process by which fatty deposits, cholesterol, and other substances build up inside artery walls, forming plaque. Over time, this plaque can narrow arteries, restrict blood flow, and—most dangerously—rupture, causing blood clots that lead to heart attacks or strokes. The disease develops silently over decades, which is why detecting it early is so valuable.\u003c\/p\u003e\n\u003cp\u003eDr. Spence makes a key point: \u003cstrong\u003edirectly measuring the burden of atherosclerosis is much better for predicting risk than calculating it from risk factor panels.\u003c\/strong\u003e This aligns with a growing shift in cardiovascular medicine toward \"imaging-based\" risk assessment.\u003c\/p\u003e\n\n\u003ch2 id=\"mesa-study\"\u003eThe MESA Study: A Major Research Effort\u003c\/h2\u003e\n\u003cp\u003eThe article at the center of this debate comes from the \u003cstrong\u003eMulti-Ethnic Study of Atherosclerosis (MESA)\u003c\/strong\u003e, one of the most influential research projects in cardiovascular medicine. MESA is a large, long-term study that enrolled participants from multiple ethnic backgrounds to investigate how atherosclerosis develops and how it predicts future cardiovascular events.\u003c\/p\u003e\n\u003cp\u003eIn 2019, Zhao and colleagues published a paper from MESA examining \u003cem\u003emultisite atherosclerosis\u003c\/em\u003e—that is, plaque buildup in different parts of the body—in people with metabolic syndrome and diabetes. The study compared how well different screening tests predicted cardiovascular events, including:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eCoronary calcium scoring\u003c\/strong\u003e – a CT scan (computed tomography) that measures calcified plaque in the coronary arteries (the arteries that supply blood to the heart muscle)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eCarotid intima-media thickness (IMT)\u003c\/strong\u003e – an ultrasound measurement of the thickness of the inner two layers of the carotid artery wall in the neck\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eAnkle-brachial index (ABI)\u003c\/strong\u003e – a simple blood pressure comparison between the ankle and the arm that can indicate blockages in leg arteries\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cp\u003eThe findings, as reported in the correspondence, showed that coronary calcium scores predicted most of the risk of cardiovascular events, with little additional contribution from carotid IMT or ABI. In other words, once you know a patient's coronary calcium score, measuring IMT or ABI didn't add much predictive value.\u003c\/p\u003e\n\n\u003ch2 id=\"tests\"\u003eUnderstanding the Tests: Coronary Calcium, IMT, ABI, and Carotid Plaque\u003c\/h2\u003e\n\u003cp\u003eTo understand the debate, it helps to know the differences between the tests being compared. They each look at atherosclerosis in different ways, at different parts of the body, and with different technologies.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eCoronary calcium scoring\u003c\/strong\u003e uses a computed tomography (CT) scan of the chest to detect and quantify calcium deposits in the coronary arteries. Because calcium accumulates in atherosclerotic plaque over time, the calcium score (often called the Agatston score) serves as a proxy for total plaque burden in the heart's arteries. Higher scores mean more plaque and higher risk. The scan is quick, painless, and requires no contrast dye, but it does involve exposure to ionizing radiation.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eCarotid intima-media thickness (IMT)\u003c\/strong\u003e uses ultrasound to measure the thickness of the two innermost layers of the carotid artery wall—the intima and the media. Increased thickness indicates early arterial wall changes consistent with atherosclerosis. It's a measure of the artery wall itself, not specifically of the plaque protruding into the artery.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnkle-brachial index (ABI)\u003c\/strong\u003e is the simplest test: it divides the systolic blood pressure at the ankle by the systolic blood pressure at the arm. A low ratio (below about 0.90) suggests there are blockages in the arteries of the legs, which is associated with widespread atherosclerosis elsewhere in the body.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eCarotid plaque burden\u003c\/strong\u003e—the measurement Dr. Spence advocates—uses ultrasound to directly visualize and measure plaque in the carotid arteries. Unlike IMT, which measures the wall thickness, plaque burden quantifies the actual plaque area or volume. This can be done with standard two-dimensional (2D) ultrasound, which measures plaque area, or with three-dimensional (3D) ultrasound, which measures plaque volume (a reflection of the total amount of disease).\u003c\/p\u003e\n\n\u003ch2 id=\"key-findings\"\u003eKey Findings: What the MESA Study Showed\u003c\/h2\u003e\n\u003cp\u003eThe MESA paper by Zhao et al. reported that \u003cstrong\u003ecoronary calcium scores predicted most of the risk of cardiovascular events\u003c\/strong\u003e, with little contribution from carotid IMT and ankle-brachial index. This means that, statistically, the coronary calcium score was the dominant predictor among the tests evaluated.\u003c\/p\u003e\n\u003cp\u003eIn response, Dr. Paolo Raggi wrote an accompanying editorial in the same journal. His now-famous statement was: \u003cem\u003e\"Coronary calcium is all we need for risk assessment, yet we do not use it often enough.\"\u003c\/em\u003e Raggi's editorial argued that coronary calcium scoring should be used more widely because it provides such strong risk prediction.\u003c\/p\u003e\n\u003cp\u003eDr. Spence agrees with part of this argument. He states clearly that \u003cstrong\u003e\"assessing burden of atherosclerosis is much better for predicting risk than calculations from panels of risk factors.\"\u003c\/strong\u003e He also agrees that coronary calcium is \"much better than IMT and ankle-brachial index\" for this purpose. So far, the authors are in agreement.\u003c\/p\u003e\n\u003cp\u003eThe disagreement lies in what was left out. Dr. Spence notes that the MESA analysis and the accompanying editorial \u003cstrong\u003eomitted mention of ultrasound measurement of carotid plaque burden\u003c\/strong\u003e—a test that he argues is at least as good as coronary calcium, while being cheaper and safer.\u003c\/p\u003e\n\n\u003ch2 id=\"radiation\"\u003eThe Hidden Cost of Coronary Calcium Scans: Radiation Exposure\u003c\/h2\u003e\n\u003cp\u003eOne of Dr. Spence's most practical concerns is radiation exposure. A single coronary calcium CT scan involves a relatively small dose of ionizing radiation—comparable to a few mammograms or chest X-rays. For most healthy people scanned once, the risk is very small.\u003c\/p\u003e\n\u003cp\u003eHowever, Dr. Spence makes an important point: \u003cstrong\u003epatients with coronary artery disease tend to have repeated exposure to radiation.\u003c\/strong\u003e These patients often undergo:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003eCoronary angiograms (invasive dye studies of the heart's arteries)\u003c\/li\u003e\n  \u003cli\u003ePercutaneous revascularization procedures (such as angioplasty and stent placement)\u003c\/li\u003e\n  \u003cli\u003eFollow-up CT scans\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cp\u003eEach of these procedures adds to a patient's lifetime radiation dose. The medical community understands that \u003cstrong\u003ethe risk of radiation is cumulative\u003c\/strong\u003e—meaning that the effects of many small exposures add up over time. While each individual scan or procedure may pose negligible risk on its own, the combined exposure across a patient's lifetime can increase the risk of cancer.\u003c\/p\u003e\n\u003cp\u003eCarotid ultrasound, by contrast, uses \u003cstrong\u003eno ionizing radiation at all.\u003c\/strong\u003e It relies on sound waves, which are harmless and have no known cumulative risk. This makes ultrasound an attractive option for patients who need repeated monitoring of their atherosclerosis over time.\u003c\/p\u003e\n\n\u003ch2 id=\"carotid-ultrasound\"\u003eWhy Carotid Plaque Ultrasound Deserves More Attention\u003c\/h2\u003e\n\u003cp\u003eDr. Spence's central argument is that ultrasound measurement of carotid plaque burden offers three key advantages over coronary calcium scoring:\u003c\/p\u003e\n\u003col\u003e\n  \u003cli\u003e\n\u003cstrong\u003eMuch lower cost.\u003c\/strong\u003e Carotid ultrasound is significantly cheaper than CT-based coronary calcium scoring. This matters both for healthcare systems and for individual patients paying out of pocket. Lower cost also makes it more feasible to repeat the test over time to track disease progression or regression.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eNo radiation exposure.\u003c\/strong\u003e As noted above, this eliminates a cumulative risk, especially important for patients who will need repeated imaging over a lifetime.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eComparable (or better) predictive ability.\u003c\/strong\u003e While the MESA analysis didn't directly compare coronary calcium with carotid plaque burden, other large studies—described below—have shown that carotid plaque burden is a strong predictor of cardiovascular events.\u003c\/li\u003e\n\u003c\/ol\u003e\n\u003cp\u003eDr. Spence is careful not to dismiss coronary calcium scoring entirely. He acknowledges it is a valuable tool—in fact, better than IMT and ABI. His point is narrower but important: \u003cstrong\u003ethe conversation about risk imaging should include carotid plaque ultrasound as a first-line option, especially in settings where cost and radiation are concerns.\u003c\/strong\u003e As he puts it, \"coronary calcium is not all we need.\"\u003c\/p\u003e\n\n\u003ch2 id=\"evidence\"\u003eWhat Other Research Says About Carotid Plaque Measurement\u003c\/h2\u003e\n\u003cp\u003eDr. Spence supports his argument by referencing a body of research on carotid plaque measurement that has accumulated over nearly two decades. One particularly notable study is the \u003cstrong\u003eTromsø Study\u003c\/strong\u003e, a Norwegian population-based study that followed \u003cstrong\u003e6,584 men and women for 10 years\u003c\/strong\u003e. Published in the journal \u003cem\u003eStroke\u003c\/em\u003e in 2011 by Mathiesen and colleagues, it examined the ability of carotid plaque area and intima-media thickness to predict first-ever ischemic stroke (stroke caused by a blocked blood vessel). The study found that carotid plaque area was a strong predictor of stroke risk, supporting the clinical value of measuring plaque directly.\u003c\/p\u003e\n\u003cp\u003eOther important research cited in the correspondence includes:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eSpence et al. (2002)\u003c\/strong\u003e – published in \u003cem\u003eStroke\u003c\/em\u003e, demonstrated that carotid plaque area is a useful tool for targeting and evaluating vascular preventive therapy. This study laid groundwork for using plaque measurements in everyday clinical practice.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eSillesen et al. (2012)\u003c\/strong\u003e – published in \u003cem\u003eJACC: Cardiovascular Imaging\u003c\/em\u003e, compared carotid plaque burden with other tests for subclinical arterial disease in the \u003cstrong\u003eHigh Risk Plaque BioImage Study\u003c\/strong\u003e, finding that carotid plaque burden performed well as a measure of subclinical atherosclerosis (disease present but not yet causing symptoms).\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eBaber et al. (2015)\u003c\/strong\u003e – also from the \u003cstrong\u003eBioImage Study\u003c\/strong\u003e, published in the \u003cem\u003eJournal of the American College of Cardiology\u003c\/em\u003e, examined the prevalence, impact, and predictive value of detecting subclinical coronary and carotid atherosclerosis in asymptomatic adults, adding further evidence that both measurements can identify high-risk individuals before events occur.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eAinsworth et al. (2005)\u003c\/strong\u003e – published in \u003cem\u003eStroke\u003c\/em\u003e, showed that 3D ultrasound can reliably measure changes in carotid plaque volume, making it a valuable tool for rapidly evaluating new therapies.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eSpence et al. (2010)\u003c\/strong\u003e – published in the \u003cem\u003eArchives of Neurology\u003c\/em\u003e, found that intensive medical therapy reduced microemboli (tiny particles traveling in the bloodstream) and lowered cardiovascular risk in patients with asymptomatic carotid stenosis (narrowing of the carotid artery without prior symptoms).\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eSpence (2014, 2017)\u003c\/strong\u003e – in \u003cem\u003eAtherosclerosis\u003c\/em\u003e and the \u003cem\u003eJournal of the American College of Cardiology\u003c\/em\u003e, discussed the time course of atherosclerosis regression and progress toward automated 3D measurement of plaque volume, suggesting that ultrasound technology is advancing to make this measurement even more practical.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cp\u003eTogether, these studies paint a clear picture: measuring carotid plaque with ultrasound is not a fringe idea. It has been validated in large populations, across multiple international research groups, and in both 2D and 3D forms.\u003c\/p\u003e\n\n\u003ch2 id=\"implications\"\u003eClinical Implications: What This Means for Patients and Doctors\u003c\/h2\u003e\n\u003cp\u003eFor patients, this correspondence reinforces an important shift in thinking: \u003cstrong\u003eyour risk of heart attack and stroke is better estimated by looking at your actual arteries than by plugging your numbers into a risk calculator.\u003c\/strong\u003e\u003c\/p\u003e\n\u003cp\u003eIf you have been told you are at \"intermediate risk\" based on traditional risk factors—like borderline cholesterol, slightly elevated blood pressure, or family history—your doctor may recommend additional testing. The question is which test. This article suggests that patients have options, and that the choice should weigh:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003eCost of the test\u003c\/li\u003e\n  \u003cli\u003eWhether you may need repeated imaging over time\u003c\/li\u003e\n  \u003cli\u003eCumulative radiation exposure (especially if you've already had angiograms, stents, or other radiation-based procedures)\u003c\/li\u003e\n  \u003cli\u003eWhat your doctor is looking for (e.g., plaque in the heart arteries vs. plaque in the neck arteries)\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cp\u003eFor doctors, the message is about \u003cstrong\u003eshared decision-making and comprehensive assessment\u003c\/strong\u003e. Coronary calcium scoring is a powerful tool—but it's not the only one. Carotid plaque ultrasound offers comparable information about systemic atherosclerosis burden at a fraction of the cost, with no radiation, and it can be repeated safely to track whether treatment is working.\u003c\/p\u003e\n\u003cp\u003eThe correspondence also has implications for health policy. If carotid plaque ultrasound is as effective as coronary calcium scoring but cheaper and safer, health systems might consider covering it as a first-line screening option for patients at intermediate cardiovascular risk.\u003c\/p\u003e\n\n\u003ch2 id=\"limitations\"\u003eLimitations of This Correspondence\u003c\/h2\u003e\n\u003cp\u003eIt's important to point out that this article is a \u003cstrong\u003ecorrespondence letter\u003c\/strong\u003e, not a new clinical trial. It presents an opinion and a critique, supported by reference to other published research. As such, it has limitations:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003eIt does not present new data comparing coronary calcium scoring and carotid plaque burden head-to-head in a single study.\u003c\/li\u003e\n  \u003cli\u003eThe author's conclusions rely on his interpretation of existing studies, and other experts (like Dr. Raggi) may interpret the same evidence differently.\u003c\/li\u003e\n  \u003cli\u003eThe original MESA analysis it critiques did not include carotid plaque burden as a measured variable, so we cannot know from that specific study how it would have compared.\u003c\/li\u003e\n  \u003cli\u003eCoronary calcium scoring may be better than carotid plaque ultrasound specifically for predicting \u003cem\u003eheart\u003c\/em\u003e events, while carotid measures may be better for predicting \u003cem\u003estroke\u003c\/em\u003e. The \"best\" test may depend on the outcome of interest.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cp\u003eNevertheless, the correspondence is valuable because it highlights a real gap in the conversation and reminds both doctors and patients that evidence-based options exist beyond the most frequently discussed tests.\u003c\/p\u003e\n\n\u003ch2 id=\"recommendations\"\u003eRecommendations for Patients\u003c\/h2\u003e\n\u003cp\u003eBased on the evidence discussed in this article, here are some practical steps to consider:\u003c\/p\u003e\n\u003col\u003e\n  \u003cli\u003e\n\u003cstrong\u003eTalk to your doctor about imaging-based risk assessment.\u003c\/strong\u003e If you're at intermediate risk (10-20% ten-year risk) based on traditional risk factors, ask whether an imaging test could help refine that estimate.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eAsk about carotid ultrasound.\u003c\/strong\u003e Specifically inquire whether carotid plaque burden measurement (not just IMT) is available and appropriate for you. If you're concerned about radiation or cost, ultrasound may be a particularly good option.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eKnow your radiation history.\u003c\/strong\u003e If you've already had multiple CT scans, angiograms, or stent procedures, mention this to your doctor. Your cumulative radiation exposure should factor into decisions about additional radiation-based testing.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eDon't ignore plaque, even if your cholesterol looks \"OK.\"\u003c\/strong\u003e Many people with heart attacks have normal cholesterol levels. Direct imaging of atherosclerosis can reveal risk that blood tests miss.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eUse imaging results to motivate prevention.\u003c\/strong\u003e Research shows that when patients see evidence of plaque in their own arteries, they're more likely to adhere to medications and lifestyle changes. A carotid ultrasound result can be a powerful wake-up call—and, conversely, a clear scan can provide reassurance.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eRemember that no single test is perfect.\u003c\/strong\u003e The best approach may combine multiple assessments. If your doctor recommends coronary calcium scoring, that's reasonable—but it's also reasonable to ask, \"Is there a radiation-free alternative?\"\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003c!-- ddn:faq:start --\u003e\n\u003ch2 id=\"ddn-faq\"\u003eFrequently Asked Questions\u003c\/h2\u003e\n\u003ch3\u003eWhat is the difference between coronary calcium scoring and carotid plaque ultrasound?\u003c\/h3\u003e\n\u003cp\u003eCoronary calcium scoring uses a CT scan to measure calcified plaque in the heart's arteries. Carotid plaque ultrasound uses sound waves to directly measure plaque in the neck arteries. Both estimate your overall plaque burden, but ultrasound is cheaper, uses no radiation, and can be repeated safely.\u003c\/p\u003e\n\u003ch3\u003eWhy does Dr. Spence say carotid plaque ultrasound should be considered?\u003c\/h3\u003e\n\u003cp\u003eDr. Spence argues that carotid plaque ultrasound is less expensive, avoids radiation exposure, and has comparable predictive ability to coronary calcium scoring. He believes the conversation about risk imaging should include it as a first-line option, especially when patients may need repeated imaging over time.\u003c\/p\u003e\n\u003ch3\u003eDoes carotid plaque ultrasound use radiation?\u003c\/h3\u003e\n\u003cp\u003eNo. Carotid plaque ultrasound uses harmless sound waves and has no known cumulative risk. Coronary calcium CT scans expose you to ionizing radiation, and repeated scans add up over a lifetime, potentially increasing cancer risk. This makes ultrasound safer for patients who need ongoing monitoring.\u003c\/p\u003e\n\u003ch3\u003eWhat did the MESA study show about coronary calcium scoring?\u003c\/h3\u003e\n\u003cp\u003eIn the MESA study, coronary calcium scores predicted most of the risk of cardiovascular events, with little additional contribution from carotid IMT or ankle-brachial index. However, the study did not directly compare coronary calcium with carotid plaque burden, which Dr. Spence says was a missed point.\u003c\/p\u003e\n\u003ch3\u003eWhat is carotid intima-media thickness (IMT) and how is it different from carotid plaque burden?\u003c\/h3\u003e\n\u003cp\u003eCarotid IMT measures the thickness of the inner two layers of the carotid artery wall, indicating early changes. Carotid plaque burden directly visualizes and measures the actual plaque area or volume. Plaque burden is a more direct measure of disease, and Dr. Spence argues it is better than IMT for risk prediction.\u003c\/p\u003e\n\u003ch3\u003eWho might benefit from asking about carotid plaque ultrasound?\u003c\/h3\u003e\n\u003cp\u003ePeople at intermediate cardiovascular risk—such as those with borderline cholesterol, slightly high blood pressure, or family history—might benefit. Also, patients concerned about radiation or cost, or those who have already had multiple CT scans or angiograms, may want to ask their doctor if carotid plaque ultrasound is appropriate.\u003c\/p\u003e\n\u003ch3\u003eWhat did the Tromsø Study find about carotid plaque area and stroke risk?\u003c\/h3\u003e\n\u003cp\u003eThe Tromsø Study followed 6,584 men and women for 10 years. It found that carotid plaque area was a strong predictor of first-ever ischemic stroke, supporting the value of measuring plaque directly. This study adds evidence that carotid plaque ultrasound is a useful tool for stroke risk assessment.\u003c\/p\u003e\n\u003c!-- ddn:faq:end --\u003e\n\n\u003ch2 id=\"source\"\u003eSource Information\u003c\/h2\u003e\n\u003cp\u003e\u003cstrong\u003eOriginal article:\u003c\/strong\u003e Spence JD. \"Coronary calcium is not all we need: Carotid plaque burden measured by ultrasound is better.\" \u003cem\u003eAtherosclerosis\u003c\/em\u003e, Volume 287, Pages 179-180.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor:\u003c\/strong\u003e J. David Spence, MD, FRCPC, FAHA — a leading researcher in stroke prevention and atherosclerosis imaging at Western University, London, Ontario, Canada.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003ePublication history:\u003c\/strong\u003e Received March 24, 2019; revised March 28, 2019; accepted April 10, 2019; published online April 17, 2019. Copyright © 2019 Elsevier B.V. All rights reserved.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDOI:\u003c\/strong\u003e \u003ca href=\"https:\/\/doi.org\/10.1016\/j.atherosclerosis.2019.04.214\"\u003e10.1016\/j.atherosclerosis.2019.04.214\u003c\/a\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eReferences discussed in this article:\u003c\/strong\u003e\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003eZhao Y, Evans MA, Allison MA, et al. Multisite atherosclerosis in subjects with metabolic syndrome and diabetes and relation to cardiovascular events: the Multi-Ethnic Study of Atherosclerosis. \u003cem\u003eAtherosclerosis\u003c\/em\u003e 2019;282:202-209.\u003c\/li\u003e\n  \u003cli\u003eRaggi P. Coronary calcium is all we need for risk assessment, yet we do not use it often enough. \u003cem\u003eAtherosclerosis\u003c\/em\u003e 2019;282:167-168.\u003c\/li\u003e\n  \u003cli\u003eSpence JD, Eliasziw M, DiCicco M, et al. Carotid plaque area: a tool for targeting and evaluating vascular preventive therapy. \u003cem\u003eStroke\u003c\/em\u003e 2002;33:2916-2922.\u003c\/li\u003e\n  \u003cli\u003eMathiesen EB, Johnsen SH, Wilsgaard T, et al. Carotid plaque area and intima-media thickness in prediction of first-ever ischemic stroke: a 10-year follow-up of 6,584 men and women: the Tromsø Study. \u003cem\u003eStroke\u003c\/em\u003e 2011;42:972-978.\u003c\/li\u003e\n  \u003cli\u003eSillesen H, Muntendam P, Adourian A, et al. Carotid plaque burden as a measure of subclinical atherosclerosis: comparison with other tests for subclinical arterial disease in the High Risk Plaque BioImage study. \u003cem\u003eJACC Cardiovasc Imaging\u003c\/em\u003e 2012;5:681-689.\u003c\/li\u003e\n  \u003cli\u003eBaber U, Mehran R, Sartori S, et al. Prevalence, impact, and predictive value of detecting subclinical coronary and carotid atherosclerosis in asymptomatic adults: the BioImage study. \u003cem\u003eJ Am Coll Cardiol\u003c\/em\u003e 2015;65:1065-1074.\u003c\/li\u003e\n  \u003cli\u003eAinsworth CD, Blake CC, Tamayo A, et al. 3D ultrasound measurement of change in carotid plaque volume: a tool for rapid evaluation of new therapies. \u003cem\u003eStroke\u003c\/em\u003e 2005;36:1904-1909.\u003c\/li\u003e\n  \u003cli\u003eSpence JD, Coates V, Li H, et al. Effects of intensive medical therapy on microemboli and cardiovascular risk in asymptomatic carotid stenosis. \u003cem\u003eArch Neurol\u003c\/em\u003e 2010;67:180-186.\u003c\/li\u003e\n  \u003cli\u003eSpence JD. Time course of atherosclerosis regression. \u003cem\u003eAtherosclerosis\u003c\/em\u003e 2014;235:347-348.\u003c\/li\u003e\n  \u003cli\u003eSpence JD. Approaching automated 3-dimensional measurement of atherosclerotic plaque volume. \u003cem\u003eJ Am Coll Cardiol\u003c\/em\u003e 2017;70:314-317.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cp\u003e\u003cem\u003eThis patient-friendly article is based on peer-reviewed research published in Atherosclerosis, one of the leading international journals in the field of vascular medicine. All statistics and study findings have been preserved from the original source. This content is provided for educational purposes and is not a substitute for professional medical advice. Always consult your healthcare provider about your individual risk and testing options.\u003c\/em\u003e\u003c\/p\u003e","brand":"DiagnosticDetectives.Com","offers":[{"title":"Default Title","offer_id":47439670902940,"sku":null,"price":0.0,"currency_code":"CHF","in_stock":true}],"url":"https:\/\/diagnosticdetectives.ch\/it\/products\/coronary-calcium-isnt-the-only-answer-why-carotid-artery-ultrasound-deserves-a-second-look","provider":"DiagnosticDetectives.Com","version":"1.0","type":"link"}