“That’s going straight to my arteries,” people joke nervously as they gulp down a scrumptious meal of fatty food.

All joking aside, people now can check whether such darkly humorous predictions have come true.

An Irvine company has developed a method for measuring fatty buildup in the arteries before it produces a heart attack or stroke. (See explanatory graphic here.)

At a time when heart disease is the No. 1 cause of death in the United States, the HeartSmart process could help reduce the tally of 900,000 heart-related fatalities per year – if it fights back competitors and conquers the challenges of the American health care system.

The technology, called HeartSmartIMTplus, uses data extracted from ultrasound pictures to analyze plaque buildup and narrowing of a patient’s blood vessels.

The patients receive HeartSmart report cards that grade their arteries on a scale from A (good) to E (greatest risk) in comparison with a 40,000-person database of other patients’ arterial health.

“It’s a very useful technology that can make a lot of difference,” says Dr. David Kawanishi, a cardiologist at Mission Internal Medical Group in Mission Viejo.

For patients who get all A’s – with minimal thickening of the linings of artery walls, little plaque buildup and no blockage – he encourages them, “Keep it that way.” He advises them to exercise more and improve their diet, especially if they have a family history of heart problems or diabetes. “Get with the program,” he says.

Patients who get C’s from HeartSmart – moderate thickening of the artery walls, calcified plaque and up to 30 percent blockage – typically will feel no symptoms and experience no decrease in blood flow. “But I’ll start them on meds to get their cholesterol down,” he says. He can use HeartSmartIMT to see whether the treatment is having the desired effect inside the arteries.

Patients whose grades are E’s have critically narrowed arteries and soft plaque that could break off and cause a fatal blood clot.

“It should be an F, like a school report card,” Kawanishi says.

“You’re beyond preventive measures,” he tells those patients. Then he prepares them for medical intervention, such as implanting stents to prop the arteries open.

Ideally, an analysis like HeartSmart’s would be performed on the coronary arteries that supply blood to the muscles of the heart. But those are too far inside the body for HeartSmart to make precise measurements via ultrasound, so the process focuses on the two carotid arteries where they pass through the neck on the way to the brain.

Medical researchers have found that many, though not all, patients with plaque buildup and blockages in their carotid arteries have much the same problems in their coronary arteries.

BEGINNINGS

HeartSmart image-analysis software was developed in the 1990s by Dr. Jacques Barth, an endocrinologist and cardiologist at USC who worked on the technology with engineers at the Jet Propulsion Laboratory in Pasadena.
He also compiled the 40,000-person database of patients’ age, sex, health and intima-media thickness – the thickness of their artery linings.

In 1997, he left USC and founded Prevention Concepts Inc. to work on refining the technology and marketing it to medical researchers.

In 2007, artery-health screening gained new prominence when it was recommended for men over age 45 and women over age 55 by the Screening for Heart Attack Prevention and Education Task Force, a national doctors group. At about the same time, the company was renamed HeartSmart Technologies and moved to Irvine. It got a $600,000 boost from outside investors, says Michael H. McCann (pictured), who was hired as chief executive.

ALTERNATIVES

HeartSmartIMTplus isn’t the only screening method for cardiovascular problems, of course. Others include:

• Doppler ultrasound, a measure of blood flow through blood vessels. A Doppler ultrasound of the carotid artery is included in the relatively low-cost Life Line package of health checks, among others.
• Cardiac calcium scoring, a measure of the amount of calcium in plaque buildup on artery walls, based on the X-ray images of a CT scan.
• Coronary CT angiogram, a picture of the heart and nearby arteries that’s based on the X-ray images of a CT scan.
• Cardiac catheterization, an operation that inserts a catheter through the bloodstream to observe directly any plaque buildup or other coronary problems.
• Echocardiogram, an ultrasound technique that captures moving images of the heart.
• Do-it-yourself intima-media thickness software, a feature that several modern ultrasound machines offer to measure the thickness of artery walls. Typically they do not provide patient report cards like HeartSmart’s.

Dr. James Lindberg, a Santa Ana-based specialist in internal medicine for corporate executives, uses both HeartSmart and calcium scoring for his patients.

HeartSmart provides slightly more useful information than calcium scoring, he says, particularly in its ability to spot soft plaque that might break off and cause a stroke. A downside is his practice’s lack of an ultrasound device – he needs to arrange for a sonographer to come in with a machine and capture the images for HeartSmart to analyze.
Another drawback is that patients often have to pay roughly $300 out of their own pockets for each HeartSmart test, because Medicare and many health insurers refuse to pay for it.

“Unfortunately, it’s not covered – like most preventive medicine, ironically,” Lindberg says. “Insurance companies will readily pay if you have a heart attack, but not it you want to avoid one.”

SLOW GROWTH

The largest concentration of physicians using HeartSmart tests is in Los Angeles, because doctors there are familiar with Barth and his work, McCann says. As the relaunched company has become more visible, more doctors in Orange and San Diego counties have adopted HeartSmart tests, he says.

“We’ve added 14 doctors since the beginning of the year, and we’re seeing several new customers every month,” McCann says. The test is available in Florida, Maryland, Utah, Wyoming and Montreal.

Still, only about 30 doctors are using HeartSmart, so the company is seeking new investment to expand its marketing.

That would be a major boost for HeartSmart on top of a minor boost the company got just last week, when McCann presented the company’s technology at the Device Fest showcase in Costa Mesa.

For his efforts, HeartSmart won an award from the Biocom trade group for being the “most life-changing” technology at the conference.

Related links:

• Corporate profile of HeartSmartTechnologies.
• Personal profile of the Michael H. McCann, the company’s chief executive.
• HeartSmart Technologies Web site.
• American Heart Association.
• Links to more online resources about heart disease and stroke.

Posted in: Heart • HeartSmart Technologies |

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