Impact of visual presentation of atherosclerotic carotid plaque on cardiovascular risk profile using mHealth technologies

Figures

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  Fig. 1. Change in the overall cardiovascular risk profile (SCORE2) from baseline to 12-month follow-up. The graph illustrates the time-course changes in the SCORE2 (Systematic COronary Risk Evaluation), a measure of cardiovascular risk, for participants in the intervention group (solid line, n = 121) and the control group (dotted line, n = 119). From baseline to the final follow-up, the intervention group showed a marked and progressive decline in SCORE2 values, indicating a significant reduction in cardiovascular risk. In contrast, the control group exhibited minimal changes, with SCORE2 levels slightly fluctuating over time but remaining near their baseline levels. The divergence between the two groups became most pronounced after 6 months (t2), with the intervention group achieving the lowest risk profile after 12 months (t4). Error bars represent 95% confidence intervals for adjusted within-subject standard errors. t0: baseline examination, t1: 3 months follow-up, t2: 6 months follow-up, t3: 9 months follow-up, t4: 12 months follow-up.

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  Fig. 2. Changes in lifestyle alterations from baseline to 12-month follow-up. Changes in lifestyle alterations from baseline (t0) to 12-month follow-up (t4) in intervention (n = 121) and control groups (n = 119). a LDL-C levels (mg/dl): The intervention group experienced a progressive and significant reduction in LDL-C levels over time compared to the control group, with marked improvements evident by t4. b HbA1c levels (%): Glycemic control, as indicated by HbA1c, fluctuated over time, with the intervention group showing improved stability after an initial rise after 3 months (t1), whereas the control group displayed more variable trends. c Systolic blood pressure (mmHg): A consistent decrease in systolic blood pressure was observed in the intervention group, achieving significant reductions by t4, while the control group showed no substantial change. d Physical activity (minutes per week): The intervention group exhibited a notable increase in physical activity after 6 months (t2), followed by a decline but maintained higher levels than baseline. The control group showed minimal variability. e Medication adherence (lower scores indicate higher adherence): Both groups showed a gradual…

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  Fig. 3. PreventiPlaque home screen. The displayed home screen of the PreventiPlaque App illustrates its core functionalities designed to support users in monitoring and reducing atherosclerotic plaque progression. The interface includes three main components: Sonographic image of atherosclerotic carotid plaque: The top section of the screen features a saved sonographic image of the user’s carotid artery, showing the presence and extent of atherosclerotic plaque. This visual serves as a personalized and educational tool for tracking vascular health. Daily Goals Section: The central triangular icon represents daily health goals, such as maintaining physical activity, adhering to a healthy diet, and avoiding smoking. A green-colored triangle indicates that all daily goals have been successfully met. This feature encourages users to maintain healthy habits consistently. Weekly Overview: The bottom row displays a compact weekly summary of the user’s goal adherence, with individual triangles corresponding to each day of the week. The color of each triangle reflects the completion status of daily goals, providing a quick visual assessment of the user’s progress over time. This overview helps…

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  Fig. 4. PreventiPlaque daily tasks. The figure illustrates three key screens of the PreventiPlaque App, showcasing its functionality to support daily health task management and adherence tracking for cardiovascular health improvement: a Daily Goal: Physical Activity (20 min): This screen highlights the user’s daily target of 20 min of physical activity. The top banner displays the goal, accompanied by a progress visualization. Below, the app shows the user’s current progress (“You have moved 0 min today”) and provides manual adjustment options using “+“ and “−“ buttons to record additional activity. b Daily medication reminder: This screen focuses on medication adherence. The interface includes a simple visual cue with icons for a pill bottle and a pill, accompanied by the question, “Have you taken your medication?” The user can log their adherence by selecting “Yes” or “No”. c Daily Smoking Goal: This screen displays the user’s smoking-related target, emphasizing abstinence with a goal of 0 cigarettes. A graphic of a cigarette and a status tracker are presented, showing progress with the message, “You smoked 0 cigarettes today.” Users can adjust their logged smoking activity using “+“…

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  Fig. 5. CONSORT flow chart. The CONSORT (Consolidated Standards of Reporting Trials) flow diagram outlines the progression of participants through the stages of a randomized controlled trial, including enrollment, allocation, follow-up, and analysis. A total of 480 individuals were assessed for eligibility, with 240 excluded due to not meeting inclusion criteria (n = 80), declining participation (n = 80), or other reasons (n = 80). The remaining 240 participants were randomized into two groups: 121 were allocated to the intervention group, and 119 to the control group, with all receiving their allocated interventions. During follow-up, 17 participants in the intervention group and 24 in the control group were lost to follow-up, with no discontinuations in either group. All participants (121 in the intervention group and 119 in the control group) were included in the final analysis, with no exclusions.