MedicalResearch.com Interview with:
Ms. Rikke Elmose Mols
Department of Cardiology, Lillebaelt Hospital-Vejle, Vejle, Denmark.
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Current ESC guidelines for patients with chest pain and low to intermediate pre-test probability of coronary artery disease (CAD) recommend control and modification of risk factors. However, patients with an elevated cardiovascular risk profile are frequently inadequately motivated for lifestyle changes and medicine adherence from knowledge about risk factors and information about risk reduction alone. Coronary artery calcification (CAC) is a marker of coronary atherosclerosis. The degree of coronary artery calcification may be assessed by the Agatston score (AS) derived by non-enhanced cardiac computed tomography, whereas non-invasive CT imaging of the coronary arteries require contrast-enhancement (coronary computed tomography angiography [CTA]). The presence of CAC is associated with an elevated probability of obstructive coronary artery disease (CAD) and an unfavorable clinical outcome. In symptomatic patients, demonstration of non-obstructive CAD identified by coronary CTA is associated with risk modifying behavior and intensified prophylactic medical treatment in observational studies. Among asymptomatic individuals, those with the highest Agatston score levels seem to be motivated for the adoption of risk modifying behaviour and visualization of CAC may stimulate adherence to lipid-lowering therapy and aspirin and a healthier lifestyle. The aim of the present prospective, randomized controlled study was to test the effect of adding visualization of coronary artery calcification to the standard information about risk and lifestyle modification on cholesterol levels and other risk markers in patients with a new diagnosis of non-obstructive CAD.
Visualization of coronary artery calcification and brief recommendations about risk modification (ESC guidelines) after coronary CTA in symptomatic patients with hyperlipidemia and non-obstructive CAD may have a favorable influence on plasma total-cholesterol concentration, adherence to statin therapy and risk behavior. Further investigations are needed.
MedicalResearch: What should clinicians and patients take away from your report?
Response: Within two weeks after randomization, patients in the intervention group were invited to a 25 minutes nurse consultation, during which the individual calcium score image was demonstrated. The exact AS was not mentioned. We used the European guidelines on cardiovascular prevention to standardize the information about risk factors of CAD and the relation between CAC and cardiovascular outcome. The information also included recommendations on target levels of total- and LDL-cholesterols, and the purpose of and potential side effects by statin and aspirin prophylaxis. Moreover, recommendations about the beneficial effects of physical activities, a healthy diet, and smoking cessation were provided. We used a motivational counselling approach in order to optimize the patient-nurse communication.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Response: There may be several mechanisms for the beneficial effect of intervention in this study. The relatively short time between the coronary CTA examination and the first follow-up consultation may have captured patients in a state of health threat, and consequently, readiness for behavioral and lifestyle changes. The latter is supported by data showing a higher efficacy in improving particularly smoking cessation in the setting of acute myocardial infarction if offering smoking counseling in-hospital and supportive contacts immediately after discharge. Moreover, previous research on strategies to communicate cardiovascular risk to patients indicate that visual displays have desirable properties enhancing understanding of risk and thus may be considered as a “wake-up call”. The use in this study of a motivational communicative approach, reflecting a patient-centered way of communication for facilitating behavioral changes, may have contributed to the tendency towards improved adherence to medication. However, whether such improved adherence and resultant reduction in total-cholesterol is associated with improved clinical outcome in patients with non-obstructive CAD identified by coronary computed tomography angiography remains to be settled in future studies.
The article published:
Mols RE, Moller JJ, Sand NP et al. Visualization of Coronary Artery Calcification: Influence on Risk Modification. Am J Med 2015;S0002-S9343