Ulf Näslund (Umeå University, Umeå, Sweden) and others report in The Lancet that sharing pictorial representations of personalised scans that show the extent of atherosclerosis to patients and their doctors results in a decreased risk of cardiovascular disease one year later, compared with people receiving usual information about their risk.
More than 3,000 (3,532) individuals who were taking part in the Västerbotten County (Sweden) cardiovascular prevention programme were included in the study and underwent vascular ultrasound investigation of the carotid arteries. Half (1,749) were randomly selected to receive the pictorial representation of carotid ultrasound and half (1,783) did not receive the pictorial information.
Participants aged 40 to 60 years with one or more cardiovascular risk factors were eligible to participate. All participants underwent blood sampling, a survey of clinical risk factors and ultrasound assessment for carotid intima media wall thickness and plaque formation. Each person 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. Thus, the study had dual targets.
Both groups received information about their cardiovascular risk factors and a motivational health dialogue to promote healthier life style and, if needed according to clinical guidelines, pharmacological treatment. At one year follow up, the cardiovascular risk score for all participants (3,175 completed the follow up) was calculated showing differences between the two groups (Framingham Risk Score decreased in the intervention group but increased in the control group [-0.58 vs +0.35]; SCORE increased by twice as much in control group compared to the intervention group [0.27 vs 0.13]).
Improvements were also seen for total and low-density lipoprotein (LDL) cholesterol in both groups, but the reduction was greater in the intervention group than in the control group. A graded effect was also noted, with the strongest effect seen for those with the worst results.
Importantly, the effect of the intervention did not differ by education level, suggesting that this type of risk communications might contribute to a reduction of the social gap in health. The findings come from a middle-aged population with low to moderate cardiovascular disease risk.
Näslund comments: “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 computed tomography (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.”
Further research is needed to understand whether the results are sustainable beyond one year, and whether the intervention will lead to a reduction of cardiovascular disease in the long-term. Formal cost-effectiveness analyses will be done after three-year follow-up.