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Discover the cost of CIMT testing and why it’s a smart investment in prevention compared to the high expenses of stroke and heart disease treatment.
Doctors have long relied on tools like the Framingham risk score to estimate a person’s likelihood of developing heart disease. While helpful, this score doesn’t capture every risk factor, especially early artery buildup that hasn’t yet caused symptoms.
The need for earlier detection is growing. In 2021 alone, heart and blood vessel conditions led to 4.7 million hospitalizations in the US, totaling $108 billion in healthcare costs. By 2030, that figure could rise to $131.3 billion.
Carotid intima-media thickness (CIMT) testing offers a way to spot artery disease early. One study showed that CIMT measurements above 1.069 mm in women and 1.153 mm in men were closely linked to coronary artery disease, which is the most common type of heart disease in the US.
This article explores how CIMT testing could help you catch heart disease early and compares the cost to the much higher expense of treating advanced conditions.
Your brain depends on a steady flow of oxygen to work properly. The carotid arteries in your neck act like major roadways, carrying oxygen-rich blood to your brain. These arteries have multiple layers, including:
When plaque or damage starts to develop in your arteries, these two layers can get thicker. If that happens, it can reduce blood flow to the brain and increase your risk of a stroke.
A Carotid Intima-Media Thickness (CIMT) test uses ultrasound to measure the thickness of these artery walls. The procedure is noninvasive, safe, and reliable, and it can detect early signs of artery hardening or narrowing, even before any blockage develops.
CIMT is usually measured in all three segments of the carotid artery located on each side of the neck:
In total, six CIMT measurements are taken. These are then averaged to get the final CIMT value.
According to the 2008 Consensus Statement from the American Society of Echocardiography (ASE), the standard method uses average CIMT values from just the right and left CCAs. A 2014 study supported this approach, noting that the CCA is easier to scan and produces more reliable results because it’s closer to the skin and runs more parallel to the surface of the neck.
However, in 2023, researchers found that using combined measurements from multiple carotid segments (common, internal, and bifurcation) gives a better prediction of future cardiovascular problems than using just one artery. They also found that the largest CCA value is a better predictor of heart attack risk than averaging the two CCA measurements.
CIMT testing methods can vary from one provider to another. It’s a good idea to ask about the method used during your test. If your test uses a less predictive method, it could underestimate or overestimate your true risk, leading to either false reassurance or unnecessary treatment.
The test usually takes 30 to 45 minutes. No injections or radiation are involved. It uses high-frequency sound waves to create images of your carotid arteries.
During the test, you’ll lie on your back on the exam table, with your head resting comfortably. Your neck will be gently tilted back and slightly turned to the side, away from the probe. To help you hold this position, a wedge pillow set at a 45-degree angle may be placed under your shoulders or upper back.
A technician will apply a special gel to your neck. This gel helps the ultrasound probe glide smoothly over the skin and allows sound waves to pass more effectively into your body.
The technician may adjust your neck position slightly to capture the best image angles, particularly from the front of your neck. Throughout the scan, you’ll be asked to remain as still as possible to ensure clear imaging.
Once the imaging is complete, the gel is wiped off, and you can resume your normal activities right away. There’s no downtime or recovery needed.
According to current guidelines:
In a study involving healthy Indian adults, the average CIMT was 0.67 mm, and the maximum CIMT observed was 0.70 mm. According to the European Society of Cardiology (ESC), a CIMT above 0.90 mm can indicate organ damage.
Your age, sex, and race can affect how CIMT results are understood. For example, Black men and women tend to have higher CIMT values than white men and women. Additionally, CIMT naturally increases by about 0.0033 mm per year as part of the normal aging process, even without signs of artery disease.
For more accurate interpretation, the ASE recommends using percentiles that account for your age, sex, and racial or ethnic background:
According to the ASE, CIMT testing can be helpful if you're at an intermediate risk for cardiovascular disease. This typically means you have a 6% to 20% chance of having a heart attack or dying from heart disease in the next 10 years, but you haven’t been diagnosed with heart disease yet.
Your doctor might also consider this test if:
However, routine CIMT testing to track changes over time is not advised. A single, properly conducted test is usually sufficient.
In the ARIC Study (Atherosclerosis Risk in Communities), experts measured CIMT in over 12,000 people aged 45 to 64. All participants were free of heart disease when the study began. They were then followed for 4 to 7 years across four US communities.
The findings showed that people with thicker artery walls (specifically those with a CIMT of 1 mm or more) had a higher risk of having a heart event. For women, the risk was about 5 times higher. For men, it was nearly 2 times higher, even after adjusting for basic factors like age and race.
The Rotterdam Study included people aged 55 and older. At the start of the study, researchers recorded ultrasound images of the carotid arteries for each participant. They then followed these people for about 2.7 years to see who experienced a stroke or heart attack.
They compared the CIMT measurements of those who had events (about 100 heart attacks and 95 strokes) with those who didn’t, using a case-control method.
People with thicker carotid artery walls had a higher chance of having a stroke or heart attack. For every small increase in CIMT (0.163 mm), the risk of stroke went up by about 41%, and the risk of heart attack increased by about 43%. Even after removing people who already had previous heart problems, the link stayed strong.
The Carotid Atherosclerosis Progression Study (CAPS) was a 4-year study and included younger people, not just older adults (aged 19 to 90). They analyzed results separately for those under 50 and those 50 or older.
Even after accounting for common risk factors (like age, sex, blood pressure, and cholesterol), CIMT remained a strong predictor.
Surprisingly, the risk was even greater in younger adults. A 0.1 mm increase in CIMT (measured in the common carotid artery or CCA) was linked to a 34% higher risk of serious events, compared to just a 10% higher risk in older adults.
While the first three studies are among the most frequently cited in support of using CIMT for cardiovascular risk assessment, several others have reported similar findings.
In 2007, a meta-analysis that combined data from eight large population-based studies, covering over 37,000 participants, found that each 0.10 mm increase in CIMT was linked to a 13% to 18% higher risk of stroke and a 10% to 15% higher risk of heart attack.
A 2008 study followed individuals with normal blood pressure for an average of 10.7 years. It found that those with CIMT values over 0.81 mm had three times the risk of ischemic stroke compared to those without thickened arteries or plaque.
This risk remained elevated even after adjusting for age, cholesterol, smoking, and other common risk factors. The study also showed that for every 0.13 mm increase in CIMT, stroke risk rose by 43%.
The out-of-pocket cost for a CIMT test can vary quite a bit depending on where you go, the provider, and whether it's bundled with other heart screenings. On average, expect to spend around $250 to $330.
Some clinics offer CIMT as part of a package. For example, Houston Methodist has a $205 “Heart Scan Plus” deal that includes both a coronary calcium CT scan and a vascular ultrasound. If you're only getting the CIMT, it’s $120. In Atlanta, one ultrasound clinic offers a combined carotid ultrasound and CIMT scan starting at $149.
It’s wise to check with local clinics or imaging centers near you and compare prices to get the best value.
Even though significant clinical literature supports CIMT as an accurate way to detect early signs of heart disease, it’s still not covered by most major health insurers, including Medicare.
Insurance companies often base coverage decisions on recommendations from governing bodies like the US Preventive Services Task Force (USPSTF) or the American College of Preventive Medicine (ACPM). However, these groups haven’t recommended for or against using CIMT for routine heart risk screening, which leaves insurers without a strong reason to cover it.
Similarly, the American College of Cardiology (ACC), American Heart Association (AHA), and the National Heart, Lung, and Blood Institute (NHLBI) reviewed the evidence on CIMT. They concluded that there wasn’t enough clear or consistent data to recommend for or against using CIMT to assess a person’s risk of having their first heart event. In other words, they didn’t endorse it, but they didn’t dismiss it either.
In contrast, the American Association of Clinical Endocrinologists (AACE) considered CIMT testing in some cases in 2017 to help better assess a person's heart disease risk. However, the support was moderate at best (Grade B, Evidence Level 2).
Because CIMT isn’t strongly backed as a standard screening tool, insurers often don’t see it as “medically necessary.” For instance, Cigna classifies CIMT as Numerous studies have validated CIMT as a reliable predictor of cardiovascular risk.
for measuring atherosclerosis or predicting heart disease. Several Blue Cross Blue Shield plans take a similar stance.
If you're considering a CIMT test, you’ll likely have to pay for it out of pocket.
When considering the value of investing in CIMT screening as a preventive measure, it helps to think about what that investment could actually save you down the line.
The test itself may cost a few hundred dollars. But if it catches early signs of artery thickening, it gives you a chance to act before things get worse. Compare that to the cost of treating a heart attack or stroke, and the difference is huge.
For perspective:
One study looked at nearly 12,000 patients in over 200 US hospitals from 2010 to 2013. On average, a single hospital stay for a heart attack costs about $18,931. This amount includes:
Most people in the study stayed for just over 3 days. The bill increased by another $3,282 if the patient required intensive care. Over the following year, post-hospital care added an average of $8,037 in additional costs.
In that study, nearly half the patients were rehospitalized, often within 2 months.
Cardiac procedures raise costs even further. Common interventions include angioplasty, stent placement, and coronary artery bypass grafting (CABG). These are among the most expensive aspects of heart attack treatment.
Even in the 1990s, the average cost of balloon angioplasty was about $4,561, while stenting reached $6,538. Today, those numbers are much higher, especially if you need CABG surgery.
Recent data shows that hospitals in the US typically charge the following for a CABG surgery:
Prices also vary widely by region. For example:
And remember, these numbers don’t even include cardiac rehab, medications, follow-up tests, or the income you might lose if you can’t work during recovery.
A one-time CIMT test in your 40s or 50s might cost around $200 to $300. Even if you decide to repeat the test every few years, your total cost over time would still be low compared to what you might pay for hospital treatment after a heart attack or stroke.
Let’s say you get 10 CIMT tests over the course of a few decades. That might total about $2,500. But if you end up in the hospital with a heart attack, the cost of that single event can easily be 10 to 20 times higher. That doesn’t include rehab, medications, or time off work.
A study in the Journal of Hypertension explored this idea using a simulated model. It looked at people between the ages 50 and 59 who were already at moderate to high risk. In the simulation, CIMT screening helped lower the risk of heart attacks by about 1% in men and 1-3% in women over 20 to 30 years.
Even when factoring in the cost of the test and any preventive treatment that followed, the numbers still favored screening. Over a 10-year period, CIMT testing was cost-effective in 66% of simulations for men and 94% for women. Over 30 years, it proved to be cost-effective for both.
The authors concluded that the results support CIMT measurements for cardiovascular risk stratification, particularly for women, when focusing on long-term health.
Let’s look at how CIMT testing compares to alternative screening methods:
In the end, the choice of test often depends on the doctor’s experience, your preference, and costs. As CIMT technology improves and becomes easier to use in everyday practice, it could eventually replace other methods as the preferred tool for assessing heart disease risk.
When you weigh the $200 cost of a CIMT test against the much higher expense of managing a heart attack or stroke, the benefit becomes apparent. This one-time screening can prompt earlier lifestyle changes or medication adjustments that potentially help you avoid serious complications.
