CT Angiography, Healthy Lifestyle Behaviors, and Preventive Therapy

IF 14.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JAMA cardiology Pub Date : 2025-06-18 DOI:10.1001/jamacardio.2025.1763

Michael McDermott, Phyo H. Khaing, Mohammed N. Meah, Kang-Ling Wang, Neil Craig, Krithika Loganath, Craig Balmforth, Edwin J. R. van Beek, John Norrie, Brian McKinstry, Bruce Guthrie, Lewis Ritchie, Dorien M. Kimenai, Nicholas L. Mills, Marc R. Dweck, Michelle C. Williams, David E. Newby

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引用次数: 0

Abstract

ImportanceHealthy lifestyles and uptake of primary preventive therapies for cardiovascular disease remain poor.ObjectiveTo determine the impact of coronary computed tomography (CT) angiography on healthy lifestyle behaviors, acceptance of recommended treatments, and modification of risk factors as compared with guideline-directed cardiovascular risk scoring.Design, Setting, and ParticipantsThis was a nested substudy conducted from September 2020 to August 2024 of a randomized clinical trial where participants underwent cardiovascular risk scoring or coronary CT angiography. Primary care–based screening took place in Scotland. Included in the analysis were asymptomatic individuals aged 40 to 70 years without known cardiovascular disease and with at least 1 cardiovascular risk factor. Study data were analyzed from August to September 2024.InterventionsAll participants received lifestyle advice with additional recommendations for moderate-intensity statin therapy if the 10-year cardiovascular risk was greater than or equal to 10% or combined antiplatelet and at least moderate-intensity statin therapies if coronary atherosclerosis was identified on CT angiography.Main Outcomes and MeasuresThe composite primary outcome was compliance with the National Institute for Health and Care Excellence recommendations for diet, body mass index, smoking, and physical exercise at 6 months.ResultsBetween September 2020 and January 2024, 400 participants were enrolled (median [IQR] age, 62 [56-65] years; 198 female [49.5%]; median [IQR] 10-year cardiovascular risk, 14% [9%-19%]) with 195 randomized to cardiovascular risk scoring and 205 to coronary CT angiography. At 6 months, those who underwent CT angiography were more likely to meet the primary composite end point (17% [33 of 194 participants] vs 6% [10 of 177 participants]; odds ratio, 3.42; 95% CI, 1.63-6.94; P &lt; .001). Compared with cardiovascular risk scoring, fewer participants were recommended preventive therapy after CT angiography (51% [105 of 205 participants] vs 75% [147 of 195 participants]; P &lt; .001), but acceptance of recommendations was higher (77% [81 of 105 participants] vs 46% [68 of 147 participants]; P &lt; .001). This resulted in similar use of lipid-lowering therapy (44% [90 of 205 participants] vs 35% [69 of 195 participants]; OR, 1.43; 95% CI, 0.96-2.15; P = .08) and greater use of antiplatelet therapy in those randomized to CT angiography (40% [83 of 205 participants] vs 0.5% [1 of 195 participants]; P &lt; .001). Participants randomized to coronary CT angiography had small incremental improvements in risk factors and 10-year cardiovascular risk, largely driven by those with CT-defined coronary atheroma.Conclusions and RelevanceResults of this cohort study reveal that compared with cardiovascular risk scoring, coronary CT angiography was associated with modest improvements in healthier lifestyle behaviors, acceptance of recommended preventive therapy, and risk factor modification. Whether this strategy reduces coronary events remains to be established.

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CT血管造影、健康生活方式行为和预防治疗

健康的生活方式和对心血管疾病初级预防治疗的接受程度仍然很差。目的探讨冠状动脉计算机断层扫描（CT）血管造影对健康生活方式、推荐治疗的接受程度和危险因素改变的影响，并与指南指导的心血管危险评分进行比较。设计、环境和参与者这是一项于2020年9月至2024年8月进行的随机临床试验的嵌套亚研究，参与者接受心血管风险评分或冠状动脉CT血管造影。以初级保健为基础的筛查在苏格兰进行。纳入分析的是年龄在40至70岁之间、无已知心血管疾病且至少有1种心血管危险因素的无症状个体。研究数据分析时间为2024年8月至9月。干预措施：如果10年心血管风险大于或等于10%，所有参与者都接受生活方式建议和中等强度他汀类药物治疗，如果CT血管造影发现冠状动脉粥样硬化，则联合抗血小板和至少中等强度他汀类药物治疗。主要结局和测量综合主要结局是6个月时遵守国家健康与护理卓越研究所关于饮食、体重指数、吸烟和体育锻炼的建议。结果在2020年9月至2024年1月期间，纳入了400名参与者(中位[IQR]年龄62[56-65]岁；女性198人[49.5%]；10年心血管风险中位数[IQR]为14%[9%-19%])，其中195人随机分为心血管风险评分组，205人随机分为冠状动脉CT血管造影组。在6个月时，接受CT血管造影的患者更有可能达到主要复合终点(17%[194名参与者中的33名]vs 6%[177名参与者中的10名]；优势比3.42；95% ci, 1.63-6.94；P, amp;肝移植;措施)。与心血管风险评分相比，CT血管造影后推荐预防性治疗的参与者较少(51%[205名参与者中的105名]vs 75%[195名参与者中的147名]；P, amp;肝移植;.001)，但对建议的接受度更高(77%[105名参与者中的81名]vs 46%[147名参与者中的68名]；P, amp;肝移植;措施)。这导致降脂治疗的使用相似(44%[205名参与者中的90名]vs 35%[195名参与者中的69名]；或者,1.43;95% ci, 0.96-2.15；P = .08)和在随机接受CT血管造影的患者中更多地使用抗血小板治疗(40%[205名参与者中的83名]vs 0.5%[195名参与者中的1名]；P, amp;肝移植;措施)。随机接受冠状动脉CT血管造影的参与者在危险因素和10年心血管风险方面有小幅改善，主要是由那些CT确定的冠状动脉粥样硬化患者推动的。本队列研究的结果显示，与心血管风险评分相比，冠状动脉CT血管造影与健康生活方式行为的适度改善、接受推荐的预防治疗和危险因素的改变有关。这种策略是否能减少冠状动脉事件仍有待确定。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JAMA cardiology Medicine-Cardiology and Cardiovascular Medicine

CiteScore

45.80

自引率

1.70%

发文量

264

期刊介绍： JAMA Cardiology, an international peer-reviewed journal, serves as the premier publication for clinical investigators, clinicians, and trainees in cardiovascular medicine worldwide. As a member of the JAMA Network, it aligns with a consortium of peer-reviewed general medical and specialty publications. Published online weekly, every Wednesday, and in 12 print/online issues annually, JAMA Cardiology attracts over 4.3 million annual article views and downloads. Research articles become freely accessible online 12 months post-publication without any author fees. Moreover, the online version is readily accessible to institutions in developing countries through the World Health Organization's HINARI program. Positioned at the intersection of clinical investigation, actionable clinical science, and clinical practice, JAMA Cardiology prioritizes traditional and evolving cardiovascular medicine, alongside evidence-based health policy. It places particular emphasis on health equity, especially when grounded in original science, as a top editorial priority.