Evaluating the Carotid Arteries Through Preventive Ultrasound Screenings is a Powerful Risk Factor for Detecting Arthrosclerosis

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HealthFair Chief Medical Officer Disagrees with the United States Preventive Services Task Force Current Recommendations for Carotid Artery Stenosis.

In February 2014, the United States Preventive Services Task Force (USPSTF) published a draft of their review and recommendations concerning screening for carotid artery stenosis (CAS). The panel concluded with moderate certainty against screening for CAS. Now “moderate certainty” means that the available evidence is sufficient to determine the effects of the preventive service on health outcomes, but confidence in the estimate is constrained by several factors.

HealthFair Chief Medical Officer, Robert Oristaglio, DO, disagrees with this recommendation on several levels. First, their decision not to recommend screening for CAS is based solely on considering carotid surgery as the sole treatment strategy. In fact, carotid artery surgery has a rather minor role to play in the treatment strategy. It is limited to people with severe carotid disease. They make up a very small percentage of those with carotid artery disease. The main purpose of evaluating the carotid arteries is NOT to screen for stenosis, although that is a secondary purpose. The main purpose is to detect atherosclerosis. The carotid arteries are sentinel arteries for that detection. The arteries are very accessible for evaluation by carotid ultrasound, which is a very accurate non-invasive modality. Atherosclerosis is a generalized process and its presence identifies that individual with atherosclerotic disease.

Dr. Oristaglio says, “Once identified, as a physician, I know that individual has atherosclerotic disease of the heart, coronary arteries, brain, kidneys, and the peripheral vasculature. I also know that the individual has a substantially increased risk for sudden cardiac death, heart attack, hypertension (high blood pressure), congestive heart failure, stroke, kidney disease, including kidney failure, and peripheral neuropathy. While it is one thing to tell an individual he or she has an increased risk of the above because of the known risk factors, including: older age, male sex, hypertension, smoking, elevated cholesterol, and diabetes mellitus; it is quite another to tell that person he or she actually has atherosclerotic disease and KNOW he or she is at substantial risk for the above.”

The medical literature is quite clear that having carotid artery disease is an independent and very powerful risk factor for the development of the above mentioned events.

This places an onus on both the person and physician to make sure visits are regular, that the goals for weight, blood pressure, blood sugar, diet, exercise, smoking cessation, and lipid values are obtained. The USPSTF does recommend all of this.

“However, it has been my experience in nearly forty years as a physician, that both my colleagues and patients take a less than aggressive approach when all that is discussed are risk factors and not actual disease, as is the case when plaque is found in the carotid arteries,” says Dr. Oristaglio.

Screening the carotid arteries for severe stenosis, while important, is quite secondary to using the carotid arteries to test for the development of atherosclerosis, which is a generalized process, places the person at increased risk for many CV events, while providing provocative impetus to be aggressive and compliant with the treatment strategies.

“I have aggressively evaluated patients throughout the years this way and this has served me and the patients well. I am not about to stop because of misguided recommendations by the USPSTF,” says Dr. Oristaglio.

About HealthFair:

HealthFair’s mission is to save and extend lives through the early detection and prevention of disease. They are the national leader of mobile health screening services providing consumers easy access to affordable, life-saving screenings using 40-foot self-contained mobile health clinics, hospital quality equipment and highly trained health professionals. HealthFair eliminates inconvenience and gives control back to the consumer by providing the right combination of tests at the lowest possible cost.

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LeAnn McDonald
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