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Executive Physical With CIMT: What the Artery Scan Adds

13 min read
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Andrew Le, MD

Andrew founded Renew Health to change how cardiovascular disease is detected and treated.

An executive physical with CIMT adds a carotid intima-media thickness scan, an ultrasound measure of the artery wall. On ultrasound, intima-media thickness is a double-line pattern on both walls of the common carotid artery, and plaque is a focal structure that encroaches into the arterial lumen (Touboul et al., Mannheim consensus 2012). In the ARIC study, adding CIMT and plaque to standard risk factors moved about 23% of participants into a different heart-risk group (Nambi et al., J Am Coll Cardiol 2010). Is it worth it? The ARIC authors said CIMT and plaque should be considered at intermediate risk, meaning a 5% to 20% estimated 10-year risk (Nambi et al., J Am Coll Cardiol 2010). General health checks offered to unselected adults had little or no effect on total or cancer deaths (Krogsbøll et al., Cochrane 2019).

The report said your arterial age was well past your real age, with soft plaque on one side. Your doctor called your cholesterol fine for now, offered a statin, and booked you for next year. You run a company on numbers. You want to know what is driving the plaque, and whether it is still growing.

What CIMT measures in an executive physical

A carotid artery has three layers. CIMT measures the inner two, the intima and media, on ultrasound. The scan also looks for plaque, the buildup that bulges into the artery.

Two things on that report matter more than any single millimeter number:

  • Plaque burden and type. Whether plaque is present, how much, and whether it looks soft or calcified. On ultrasound, uniformly echolucent (dark) plaque is mostly lipid and necrotic material (Fedak et al., J Ultrason 2020).
  • Arterial age. The age your artery wall looks like, read against your real age. A clinician reads it with your history and labs. The grading is your clinician's job, done with you.

What executive physical programs typically include

Atlantic Health's executive program page lists a complete blood count and extensive preventative chemistry panel, an advanced coronary risk and lipid panel, and a cardiovascular evaluation, and says its cardiovascular fitness evaluation may include VO2 max and anaerobic threshold, body composition analysis, and a DEXA scan for bone density (Atlantic Health Executive Health). Cleveland Clinic's exam page says tests might include a variety of blood tests, an electrocardiogram (EKG), a cardiac stress test, a calcium-score screening heart scan, vascular screening tests, and a bone density test (Cleveland Clinic exam). Atlantic Health says you meet with your coordinating physician and a team of specialists, complete your screenings and review your results face-to-face, with recommendations for nutrition, exercise, stress and follow-up care.

Advanced cardiovascular risk assessment

The 2018 AHA/ACC cholesterol guideline (Grundy et al.) starts with a 10-year risk estimate, then uses risk-enhancing factors such as apoB of 130 mg/dL or higher, Lp(a) of 50 mg/dL (125 nmol/L) or higher, and hs-CRP of 2.0 mg/L or higher, which favor statin therapy at intermediate risk (7.5% to 19.9%). If risk status is uncertain, the guideline says to consider using coronary artery calcium to improve specificity (Grundy et al., Circulation 2019). CIMT adds a picture of the carotid wall to that blood work, as described in the ARIC section below.

Genetic and biomarker testing alongside CIMT

Blood markers and inherited risk describe what may be driving the wall that CIMT pictures. The 2018 AHA/ACC cholesterol guideline by Grundy and colleagues lists risk-enhancing factors that include family history of premature ASCVD, persistently elevated LDL-C of 160 mg/dL or higher, metabolic syndrome, chronic kidney disease, and chronic inflammatory disorders (Grundy et al., Circulation 2019). Grundy and colleagues say that in adults at intermediate risk, risk-enhancing factors favor initiation of statin therapy, and that if risk status is uncertain, coronary artery calcium can improve specificity.

Lipoprotein(a). An AHA scientific statement on lipoprotein(a) says Lp(a) levels are about 70% to 90% or more genetically determined (AHA Lp(a) statement, PMC9989949). The AHA Lp(a) statement says cascade screening of family members of patients with elevated Lp(a) may identify additional individuals with elevated Lp(a), because of its autosomal codominant inheritance pattern. The same AHA statement says the evidence in favor of screening for Lp(a) is the strongest for those with a family or personal history of ASCVD, and that various organizations have proposed to obtain a level once in every adult.

How the numbers are used together. The 2019 ACC/AHA prevention guideline by Arnett and colleagues says that in adults at borderline risk (5% to under 7.5%) or intermediate risk (7.5% to under 20%), it is reasonable to use additional risk-enhancing factors to guide decisions about preventive interventions such as statin therapy (Arnett et al., Circulation 2019). Your clinician reads these markers next to the CIMT report and your 10-year risk estimate.

Questions to ask

  • Ask whether Lp(a), apoB, and hs-CRP are on your panel, and who reviews them with your scan.
  • Ask whether a high Lp(a) result means your family members should be tested.

How the CIMT scan is done

RadiologyInfo says carotid ultrasound uses sound waves to produce pictures of the carotid arteries in the neck, which carry blood from the heart to the brain, and that a Doppler ultrasound study is usually part of this exam (RadiologyInfo: Carotid ultrasound). RadiologyInfo says ultrasound uses a small probe called a transducer and gel placed directly on the skin, and that ultrasound imaging is extremely safe and does not use radiation. RadiologyInfo says carotid ultrasound is most frequently used to screen patients for blockage or narrowing of the carotid arteries, a condition called stenosis, which may increase the risk of stroke.

What the research says CIMT adds

In the ARIC study, investigators followed a cohort (n = 13,145) for about 15 years. Adding CIMT and plaque to traditional risk factors moved about 23% of participants into a different risk group, and improved prediction of coronary heart disease (Nambi et al., J Am Coll Cardiol 2010). The authors said it should be considered in the intermediate-risk group (5% to 20% estimated 10-year risk). More people were moved to a lower risk group than a higher one, so a reassuring scan is useful information too.

A UK Biobank analysis (n = 29,292, ages 40 to 69) found that CIMT of 800 µm was linked with about twice the risk of coronary heart disease (hazard ratio 2.15) over a median 4.3 years. A higher combined burden of cardiometabolic risk factors went with a thicker artery wall (Mitra et al., Am J Prev Cardiol 2025).

What CIMT leaves open

Carotid ultrasound uses sound waves to produce pictures of the carotid arteries in the neck (RadiologyInfo: Carotid ultrasound). Carotid intima-media thickness is read on that ultrasound as a double-line pattern on both walls of the common carotid artery (Touboul et al., Mannheim consensus 2012). A cardiac CT scan for coronary calcium is a noninvasive way of obtaining information about the presence, location and extent of calcified plaque in the coronary arteries (RadiologyInfo: Calcium scoring). Coronary disease can be present without calcium, and a calcium score may not detect that noncalcified plaque (RadiologyInfo: Calcium scoring). The ARIC authors also wrote that ultrasound-based strategies still need trials to show they prevent events. A scan tells you where you stand. The work after the scan is what changes the number.

For how the two scans compare, see CIMT vs calcium score. If a calcium score is already on your list, see executive physical with calcium score.

Is an executive physical with CIMT worth it?

A Cochrane review pooled randomized trials of general health checks in adults picked without regard to disease or risk. It found 17 trials, 15 with outcome data (n = 251,891). Offering checks had little or no effect on total or cancer deaths, and probably little or no effect on cardiovascular deaths (Krogsbøll et al., Cochrane 2019). That argues against a big test day for its own sake.

It says less about a person who already has a finding. If your CIMT showed plaque or an older arterial age, the scan is worth it when it starts a plan and gets repeated, so you can see whether the plan worked.

Where Renew fits

Every Renew membership includes CIMT arterial imaging, advanced lab panels testing for 33 known drivers of arterial damage, a dedicated physician, and a care coordinator (Pricing). The 33-driver workup is labs and root-cause testing for known drivers of arterial damage: inflammation, metabolic, genetic, infectious, sleep, and oral pathogens (Executive health). Every membership includes the Root Cause Workup (OralDNA, Sleep, Genetics) 1x/year (Pricing). Pricing lists these tests as included in every membership: Advanced Inflammation Panel, Insulin Resistance Panel (with OGTT), Lipoprotein Panel (Lp(a), ApoB), Genetic Testing (ApoE, KIF6, 9p21), OralDNA Testing, Sleep Study, and Vitamin & Metabolic Panel (Pricing). Month one is a full intake, CIMT imaging, the 33-driver panel, an OralDNA test, and a dental exam. In month two your physician builds a protocol of medications, supplements, nutrition, and exercise based on your drivers.

A steady scan is the first win, because it means the disease stopped progressing.

Performance (primary). Performance includes Full Arterial Reversal plus Coached Strength & Body Composition: monthly physician visits, tune-up labs 4x/year, "Monthly S&C coaching sessions," "Monthly nutritionist sessions," "DEXA body composition scans (2x/year)," and "VO2 Max testing (2x/year)." Performance also adds in-home phlebotomy and an annual Executive Health Report.

Executive (secondary). Executive includes everything in Performance, plus "Weekly S&C coaching sessions," "DEXA body composition scans (4x/year)," "VO2 Max testing (4x/year)," "Meal delivery or personal chef meal prep," "All supplements included & shipped monthly," custom compounded medications, a sleep specialist, CIMT plus advanced arterial imaging, and unlimited physician access.

Your care team works on your arteries together: a Physician, an S&C Coach, a Nutritionist, a Dental Liaison, and a Care Coordinator who is your direct line. Renew operates outside insurance (Pricing). Medicare does not cover the membership. The full tier table, including the lighter Essentials and Reversal plans, is on Pricing.

Frequently asked questions

What is an executive physical with CIMT?

An executive physical with CIMT adds a carotid intima-media thickness scan, an ultrasound measure of the artery wall. On ultrasound, intima-media thickness is a double-line pattern on both walls of the common carotid artery, and plaque is a focal structure that encroaches into the arterial lumen (Touboul et al., Mannheim consensus 2012). In the ARIC study, adding CIMT and plaque to standard risk factors moved about 23% of participants into a different heart-risk group (Nambi et al., J Am Coll Cardiol 2010).

Is an executive physical with CIMT worth it?

The ARIC authors said CIMT and plaque should be considered at intermediate risk, meaning a 5% to 20% estimated 10-year risk (Nambi et al., J Am Coll Cardiol 2010). General health checks offered to unselected adults had little or no effect on total or cancer deaths (Krogsbøll et al., Cochrane 2019).

Is CIMT better than a calcium score?

Carotid ultrasound uses sound waves to produce pictures of the carotid arteries in the neck (RadiologyInfo: Carotid ultrasound). Carotid intima-media thickness is read on that ultrasound as a double-line pattern on both walls of the common carotid artery (Touboul et al., Mannheim consensus 2012). A cardiac CT scan for coronary calcium is a noninvasive way of obtaining information about the presence, location and extent of calcified plaque in the coronary arteries (RadiologyInfo: Calcium scoring).

Does Renew include CIMT in the executive physical?

Yes. Every Renew membership includes CIMT arterial imaging, advanced lab panels testing for 33 known drivers of arterial damage, a dedicated physician, and a care coordinator (Pricing). Performance and Executive membership are Renew's executive-health path (Executive health).

Does insurance cover a Renew executive physical?

Renew operates outside insurance (Pricing). Medicare does not cover the membership.

Sources

Author and medical review

Written by Andrew Le, MD. Andrew Le, MD reviews patient-facing guidance for Renew Health with a focus on preventive cardiology and functional medicine clarity.

Medically reviewed by Clinical Review Team.

Next step

If your CIMT already showed plaque or an older arterial age, start with Performance at $999/mo on executive health. Executive at $5,000/mo is listed on the same page.

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