Key result
Pictorial presentation of subclinical atherosclerosis significantly reduces cIMT progression versus control.
Why the study?
Reduced progression of atherosclerosis can decrease the risk of cardiovascular disease, but the effect of pictorial presentation of subclinical atherosclerosis on carotid atherosclerosis progression was unknown.
Does an image-based presentation of subclinical atherosclerotic severity reduce the progression of carotid atherosclerosis in adults aged 40-60 years in a CVD prevention program?
RCT (n=3,154)
open-label blinded end-point
randomised
Does an image-based presentation of subclinical atherosclerotic severity reduce the progression of carotid atherosclerosis in adults aged 40-60 years in a CVD prevention program?
Mean Difference: -0.011
p-value: p=0.001
Providing patients and physicians with pictorial presentations of subclinical atherosclerosis severity from carotid ultrasound modestly reduces left cIMT progression over 3 years.
Supports pictorial subclinical atherosclerosis feedback in CVD prevention; extends visual risk communication evidence for slowing cIMT progression.
OBJECTIVES: Reduced progression of atherosclerosis can decrease the risk of cardiovascular disease (CVD). This study aimed at evaluating the effect of a pictorial intervention showing atherosclerotic severity on the progression of carotid atherosclerosis. METHODS: A prospective randomised open-label blinded end-point trial with participants aged 40-60 years enroled from a routine CVD prevention programme. The intervention group (n: 1575) and their treating physicians received an image based presentation of subclinical atherosclerotic severity measured by carotid ultrasound. The control group (n: 1579) did not receive any information about ultrasound results. Carotid ultrasound at baseline and at 3-year follow-up contained plaque detection and measurements of carotid intima media thickness (cIMT). The left, right and bilateral-mean-cIMT, plaque prevalence and total plaque area (TPA) at 3-year follow-up were compared between groups. Significance level was set to p = 0.01 to adjust for multiple comparisons. RESULTS: The intervention group revealed reduced cIMT progression in the left-mean-cIMT of -0.011 mm (p = 0.001) compared with the control group. The intervention effect on cIMT progression was most prominent in individuals with increased cIMT and plaque prevalence at baseline (-0.021 mm, p = 0.005). There were no differences in progression between groups for the right-and bilateral-mean-cIMT (-0.005 mm, p = 0.223 and -0.005 mm, p = 0.036, respectively), nor any differences between groups for plaque prevalence or TPA (odds ratio 0.88, p = 0.09 and 0.89, p = 0.21, respectively). CONCLUSION: Pictorial presentation of subclinical atherosclerotic severity sent to both the individual and their treating physician resulted in significantly reduced left cIMT progression. Pictorial presentation has the potential to increase adherence in CVD prevention.
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Nyman et al. (2023) conducted an RCT in subclinical atherosclerosis (n=3,154). Pictorial presentation of subclinical atherosclerotic severity vs. No information about ultrasound results was evaluated on Progression of left-mean carotid intima media thickness (cIMT) (MD -0.011 mm, p=0.001). Pictorial presentation of subclinical atherosclerotic severity significantly reduced left carotid intima media thickness progression compared with control (difference -0.011 mm, p=0.001).
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