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CIMT testing uncovers hidden stroke risk—even with normal blood pressure. See why artery thickness could double your risk. Ask your doctor about CIMT today.
Stroke is one of the top causes of death and long-term disability. Many people focus on blood pressure control to lower their risk—but is that enough?
A new study shows that even with well-managed blood pressure, stroke risk stays high if the walls of your arteries are thick. This thickening, measured by a test called carotid intima–media thickness (CIMT), can quietly raise your risk.
CIMT offers a better way to spot hidden stroke risk before it’s too late. It reveals early artery damage and helps doctors catch warning signs that other tests might miss.
In this article, you’ll learn why CIMT matters and how it could help prevent strokes.
According to a study, CIMT strongly predicts stroke in Black adults with hypertension. In the study, 1,647 participants from the Jackson Heart Study were tracked for over 14 years. None had a history of cardiovascular disease at the start. The average age was 57 years. Every 0.17 mm increase in cIMT led to about a 30% higher risk of stroke. This link remained strong even when blood pressure was well controlled. For those with systolic blood pressure under 120 mm Hg, stroke risk still rose by 56% per 0.17 mm cIMT increase.
So, even if someone manages their blood pressure well, higher CIMT levels still signal danger.
Additionally, participants in the highest CIMT quartile—those with thickness above 0.84 mm—had more than twice the risk of stroke compared to those in the lowest quartile (below 0.63 mm). Incident stroke rates followed a steady rise across quartiles: 2.93, 5.3, 5.8, and 10.81 strokes per 1,000 person-years from the lowest to highest quartile. This pattern shows a clear, measurable increase in stroke risk with thicker arterial walls.
The study also explored how cIMT could improve existing prediction tools. When added to the pooled cohort equations (PCE)—a standard model for estimating cardiovascular risk—CIMT helped identify hidden risk. About 32% of participants were reclassified. Of those who had strokes, 45% were correctly reclassified into a higher-risk group. On the other hand, 6% of stroke-free individuals were correctly moved to a lower-risk category. This gave a net reclassification improvement of 0.22, showing that cIMT adds real value in personalizing risk.
CIMT also proved useful for those considered low or borderline risk by PCE alone. Many of these individuals had a higher actual stroke risk that went undetected until cIMT was factored in.
So, using CIMT could help prevent strokes by flagging people who might otherwise be overlooked.
Another important finding from the same study was that stroke risk stayed high in individuals with controlled systolic blood pressure. For example, those with SBP below 120 mm Hg but a CIMT above 0.84 mm still experienced stroke rates of 7.32 per 1,000 follow-up years. This was more than double the rate of those with low SBP and low cIMT.
This means blood pressure control alone might not fully protect against stroke if vascular damage has already developed.
That’s why CIMT is crucial. It gives a direct look at the health of your arteries, acting like a window into the long-term effects of hypertension. It captures the “wear and tear” of high blood pressure over time. According to the researchers, about 19% of the total link between hypertension and stroke was explained through increased CIMT. This shows how important artery wall thickening is in the stroke pathway.
CIMT test is a simple, painless, and noninvasive procedure that checks the thickness of the inner two layers of the carotid artery wall—the intima and media. This is done using ultrasound technology.
Along with the CIMT test, there are other ways to lower your chances of having a stroke—like the steps below.
According to Harvard Health Publishing, high blood pressure is the leading cause of stroke in both men and women. In fact, it can double or even quadruple your risk if left uncontrolled.
To lower this risk, adults are encouraged to aim for a blood pressure of less than 120/80, though for some, a slightly higher target like 140/90 may be more appropriate depending on medical advice. Practical steps include eating no more than 1,500 milligrams of salt each day, avoiding high-cholesterol foods like burgers and cheese, and eating more fruits, vegetables, whole grains, and fish.
Regular exercise and quitting smoking also help. If lifestyle changes are not enough, blood pressure medicine may be needed. These steps are vital because controlling blood pressure lowers the force on blood vessels, reducing the chance of a clot or rupture in the brain.
Harvard Health Publishing also reported that obesity increases stroke risk by raising blood pressure and causing diabetes. However, losing even just 10 pounds can significantly reduce your risk. A good goal is to keep your body mass index (BMI) below 25, although this may vary for some individuals.
To lose weight, people are advised to eat between 1,500 and 2,000 calories per day, depending on their level of activity, and to add more daily physical movement like walking or playing sports. Losing weight lightens the load on your heart and blood vessels, making strokes less likely.
Exercise not only supports weight loss and lowers blood pressure, but also directly lowers stroke risk. Getting moderate exercise at least five days a week. This could include walking after breakfast, joining a fitness group, or taking the stairs instead of the elevator. Even short sessions of 10 to 15 minutes, done several times a day, are beneficial.
Physical activity helps blood flow better and keeps blood vessels flexible, which lowers the chance of clots forming.
Drinking too much alcohol is linked to higher blood pressure and a greater risk of stroke. The goal is to drink moderately or not at all. Men should have no more than two drinks a day, and women should stick to one.
Red wine may be a better option than other alcohols for heart health, but portion size is key—just 5 ounces of wine, 12 ounces of beer, or 1.5 ounces of liquor counts as one drink. Limiting alcohol helps your blood pressure stay in a healthy range and protects your brain’s blood vessels.
High blood sugar from diabetes damages blood vessels over time and makes clots more likely. Managing your blood sugar through proper diet, exercise, and medications is crucial. Regular monitoring and keeping your levels within the recommended range helps protect your brain from stroke. When blood sugar is stable, your blood vessels stay healthier and less prone to blockages.
Smoking is extremely harmful because it thickens the blood and adds plaque to the arteries. Both of these effects increase the chance of a clot forming and causing a stroke. Quitting smoking is one of the most effective ways to prevent stroke. Help is available through nicotine patches, pills, counseling, and medical support. Even if quitting is hard and takes several tries, each effort brings you closer to success.
Once you stop smoking, your blood becomes healthier and your arteries get stronger, making stroke much less likely.
The Centers for Disease Control and Prevention (CDC) added that people with health problems like high blood pressure, high cholesterol, heart disease, or diabetes should work closely with their health care team.
The CDC advised checking cholesterol every 5 years and managing blood pressure even if there are no symptoms. Medicines may be needed, and following the doctor’s directions is very important.
The CDC also pointed out that if you’ve had a stroke or a mini-stroke before, you must stick to your treatment plan to avoid another one. These actions help reduce the risk of a second stroke and support long-term brain health.
Managing blood pressure isn’t enough on its own. You also need to know what’s happening inside your arteries.
Are they already damaged? Are you unknowingly at risk? CIMT helps answer these questions.
