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Atherosclerosis images help reduce cardiovascular risk

Tuesday December 4th, 2018

Showing people images of their atherosclerosis is an effective way to prompt behaviour change to reduce their risk of cardiovascular disease, Swedish researchers report today.

While smoking cessation, increasing physical activity, being prescribed statins and antihypertensive medication are the most appropriate interventions, low adherence to medication and lifestyle changes mean that these types of prevention efforts often fail.

However, a randomised trial of more than 3,000 people in Sweden found that seeing images of the potential damage made a difference.

Professor Ulf Näslund, of Umea University, said: “Information alone rarely leads to behaviour change and the recall of advice regarding exercise and diet is poorer than advice about medicines. Risk scores are widely used, but they might be too abstract, and therefore fail to stimulate appropriate behaviours.

“This trial shows the power of using personalised images of atherosclerosis as a tool to potentially prompt behaviour change and reduce the risk of cardiovascular disease.”

The Lancet reports that 3,532 people aged 40-60 took part in the Västerbotten County (Sweden) cardiovascular prevention programme and underwent vascular ultrasound investigation of the carotid arteries.

Of these, 1,749 were randomly selected to receive the pictorial representation of carotid ultrasound, with the remaining 1,783 receiving just information.

Both groups received information about their cardiovascular risk factors and a motivational health dialogue to promote healthier life style and any required pharmacological treatment.

Those in the intervention group received a pictorial representation of plaque formation in their arteries, and a gauge ranging from green to red to illustrate their biological age compared with their chronological age. They then received a follow up call from a nurse after two to four weeks to answer any questions. The same pictorial presentation of the ultrasound result was also sent to their primary care doctor.

At one year follow up, the cardiovascular risk score for the 3,175 participants who completed the follow up was calculated showing differences between the two groups decreased in the intervention group but increased in the control group.

Improvements were also seen for total and LDL cholesterol in both groups, but the reduction was greater in the intervention group than in the control group.

Professor Näslund said: “The differences at a population level were modest, but important, and the effect was largest among those at highest risk of cardiovascular disease, which is encouraging. Imaging technologies such as CT and MRI might allow for a more precise assessment of risk, but these technologies have a higher cost and are not available on an equitable basis for the entire population.

“Our approach integrated an ultrasound scan and a follow up call with a nurse, into an already established screening programme, meaning our findings are highly relevant to clinical practice.”

The researchers say that further research is needed to understand if the results are sustainable beyond one year.

Näslund U, Ng N, Lundgren A et al. Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA): a pragmatic, open-label, randomised controlled trial. Lancet 3 December 2018; doi:10.1016/ S0140-6736(18)32818-6

Tags: Europe | Heart Health

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