Visualization of coronary artery calcium images improved risk factors and medication adherence at 3 years but showed no sustained benefit on 10-year cardiovascular risk or events.
Does patient visualization of coronary artery calcium images and a nurse-led CVD risk reduction program improve long-term CVD risk scores, medication adherence, and prevent CVD events in asymptomatic, statin-naïve individuals with a family history of early-onset CAD?
The short-term benefits of CAC image visualization on cardiovascular risk modification and medication adherence are not sustained at 10 years, emphasizing the need for continuous risk communication.
Abstract Background Patient visualization of coronary artery calcium (CAC) images has been shown to improve cardiovascular risk factor modification and medication adherence in the primary prevention of cardiovascular disease (CVD) in the short term. Purpose This study aimed to assess whether changes in CVD risk and adherence to cholesterol-lowering therapy (CLT) observed three years after CAC image visualization within a CVD risk discussion are sustained over 10 years in high-risk asymptomatic individuals. Methods This study is a 10-year observational follow-up of a randomized controlled trial involving asymptomatic, statin-naïve individuals aged 40–70 years with a family history of early-onset coronary artery disease and a CAC score of 1–400. Participants were randomized to either a nurse-led CVD risk reduction program (n=129) or standard care (n=129), with biannual reviews. At the three-year study endpoint, participants and their primary care physicians received a personalized CVD report, and subsequent management continued within the community. The primary outcomes were the change in pooled cohort equation (PCE) risk score, CLT adherence at 10 years and CVD events. Results No difference in the change of PCE (difference in differences (DID): -0.8% 95%CI: -2.2 to 0.6%) or low-density-lipoprotein-cholesterol (DID -0.3 [95%CI: -0.6 to 0.1) was observed between intervention and control groups over ten years (Table, Figure a& b). CLT adherence proportion of users decreased from 88% to 70%, whereas the control group increase CLT use from 8% to 56% (Figure c). A total of 15 CVD events were observed with no difference between intervention and control (p=0.056). Conclusion The significant benefits observed at year 3 from CAC visualization and CVD risk discussion was not sustained over the long-term, suggesting the importance of ongoing risk communication and maintaining optimal medication adherence over timeTable 1 Figure 1
Whitmore et al. (2025) studied this question. Visualization of coronary artery calcium images improved risk factors and medication adherence at 3 years but showed no sustained benefit on 10-year cardiovascular risk or events.