SonoSite’s New Push: Ultrasound for an Up-Close Look at Heart Attack Risk

7/26/10Follow @xconomy

Now I say this for sure, I’m not going to drop dead from a heart attack anytime soon.

Sure, I’ve seen the doctor before and had all the usual heart disease tests done—cholesterol counts, measurements of fat in the blood (triglycerides), blood pressure, the old-fashioned family history. But now I got some unequivocal signs on a high-resolution screen, which I could see in real-time, about how my arteries looked during an ultrasound scan at Bothell, WA-based SonoSite (NASDAQ: SONO).

SonoSite is pitching doctors on using ultrasound as one more tool in the endless battle to help predict, and possibly prevent, life-threatening cardiovascular events. The company is urging primary care doctors to use its portable ultrasound imaging machines to look inside a couple of arteries, to see precisely just how much plaque is building up there.

The company is so pumped about what this test can do, it invited me over to its offices last week to experience it firsthand. Even though I’m not personally worried about having a heart attack or stroke, and I certainly wouldn’t spend my own time and hard-earned money on such a test, I figured I’d give it a try because so many people are curious. Pfizer’s cholesterol-lowering drug atorvastatin (Lipitor) became the world’s best-selling drug with more than $12 billion in annual sales based on the notion that it could help people lower their risk of cardiovascular disease beyond improving their diet and exercise. In a country where junk food and the sedentary lifestyle rule, there are plenty of doctors looking for ways to strike genuine fear into patients with a new, more visual way of illustrating serious health risks. An estimated one in three people die from cardiovascular disease.

“There’s a whole community in medicine now that is serious about wanting to help people avoid a heart attack,” says SonoSite CEO Kevin Goodwin.

Kevin Goodwin

Kevin Goodwin

The test, which has actually been around a few years, is what’s called the Carotid Intima-Media Thickness (CIMT) exam. This is a measurement of the two inner layers of the carotid artery—an artery on each side of the neck that supplies the brain with blood. Studies over the past 20 years have shown that a thickening of this arterial wall can be an early sign of heart disease risk, at least when people are compared with peers of the same age, race, and gender.

SonoSite’s idea is to make this test fast and easy enough so that a primary care physician can incorporate it into his or her ordinary workday. SonoSite sells the doctor a $4,000 software upgrade, loaded with algorithms to analyze data on arterial thickness, and installs it on one of the company’s portable ultrasound machines. The exam itself usually takes 10 minutes or less.

Sharon Hall, one of the company’s sonographers, showed me how this works inside an exam room at the company. She ran the ultrasound probe along the right side of my neck, and then the left side, looking at real-time images of the two main arteries sending oxygenated blood to my brain.

I turned 35 the day before this test. That was important to know, because the data from this CIMT study is thought to be most useful when compared against other white men in my age bracket.

Watching my carotids on the screen didn’t offer up any surprises. I run four miles a day, and bike an average of six to eight miles a day when I’m home in Seattle. My arteries looked wide open on the ultrasound screen.

But that wasn’t the last word, because this test takes quantitative measurements of arterial thickness that you can’t see with the naked eye. Sure enough, there was zero plaque buildup in my arteries, and the arterial wall thickness was about what is expected of a 28-year-old man. (For any primary care docs or cardiologists in the audience, if you want to interpret my report for free, click here.)

Mainly, Hall says, the SonoSite test will be used by primary care physicians with an emphasis on preventive medicine. SonoSite says about 100 of these CIMT software upgrades have been sold to doctors, but that it doesn’t really know how many patients have gotten this same exam. There are about 134,000 primary care physicians in the U.S., and about 24,000 cardiologists who might be interested in using an ultrasound CIMT test to track progress of their patients over time. Most cardiologists treat sick patients, rather than try to keep healthy patients from getting sick, so it’s hard to see exactly why they’d want this tool for prevention.

I didn’t get a hard number on what the test actually costs per patient, but it would have to factor in the physician’s time, the cost of a SonoSite ultrasound machine ($24,000 to $40,000), the $4,000 for the initial software license and $2,500 for additional licenses, and the cost of running the medical practice, according to David Levesque, SonoSite’s vice president of market development for cardiovascular disease management.

For that cost, what’s the benefit? This is something health economists could spend years trying to answer through following patients after CIMT exams, and following up on whether they changed their behavior and actually lowered their risk of heart attack. But SonoSite is going to pitch it for the time being on the potential for savings to the healthcare system—kind of an important concept in the era of healthcare reform.

“We believe it has great potential as medicine becomes more focused on prevention as a means of reducing morbidity, mortality, and end stage disease treatment,” Levesque says. “The cost-benefit ratio for CIMT versus heart catheterization, CT, and/or MRI is significantly better for everyone involved.”

When I followed up after my test with Goodwin, SonoSite’s CEO, he didn’t really say how much of an earnings driver this sort of test could be for the company, or how widely it could catch on in primary care medicine. He wanted to talk about lots of other applications for ultrasound, which are probably worth stories for another day. But the main theme, of using ultrasound images for preventive medicine, is certainly a big idea, and CIMT tests are just one component. Essentially, it’s one thing when your doctor lectures you about some abstract cholesterol score on a piece of paper. It’s another thing when the patient can see in real-time that his arteries are clogged up, and blood is struggling to get to his brain.

If I had seen that on the screen, I would probably have been scared straight and quit eating half of the junk I eat today.

“It’s quantitative, stratified, and provides a visual demonstration,” Goodwin says. “This shows the power of visualization at its best.”

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  • Pey

    Luke,

    I enjoyed your article very much. I work in cardiology research in Seattle and use SonoSite’s ultrasound machine on a daily basis. I routinely peek into patient’s carotid arteries and measure IMT readings, preparing papers for scientific journals and notifying their doctors if we see advanced stenosis, or narrowing of the arteries.

    Though the intent of your article I’m sure was to explore SonoSite’s potential profitability, I’d just like to clarify one point here: Your carotid IMT layer, or any other measure of what is happening in those arteries in the neck, is an indicator of your stroke risk, rather than heart attack risk. Risk of stroke is particularly accelerated by high blood pressure and smoking while risk of heart attack has more to do with cholesterol.

    Believe it or not, the two aren’t necessarily correlated, which is why most vascular doctors do not routinely prescribe statins for patients who have plaque buildup in the carotid arteries. There is not sufficient evidence to show lowering cholesterol with a statin can positively effect your risk of a stroke and treating high blood pressure is correlated with more beneficial outcomes and a reduced risk of stroke; unfortunately, lowering cholesterol is not thought to help as much in this regard.

    So, I may suggest changing the title of your article to “SonoSite’s New Push: Ultrasound for an Up-Close Look at Stroke Risk” since it’s technically not correct to say a carotid ultrasound has any bearing on what’s happening in your coronary arteries. There are ultrasound images you can take to examine the coronary arteries with SonoSite’s machine, though it would be a stronger probe that could move through muscle and more tissue to provide a clear image.

    Great article, though. I thought it was an excellent read.