In an early overview of Scot-Heart 2, ACCT has led more patients in primary prevention to make changes to reduce their MCV risk.
The use of CT (CCTA) coronary angiography is associated with greater adhesion early with lifestyle recommendations and acceptance of preventive medical therapy compared to a risk score in adults without cardiovascular disease SCOT-HEART 2 trial.
The results are increasingly the idea that ACTC’s results motivate patients and doctors to make positive changes, but additional research is necessary to show an effect on difficult results, according to researchers.
“To tell someone that their risk on x number of years is 10% or 15% … feels away, as an abstract result, and I think that the motivation for change in this situation can be quite low,” author Michael McDermott, MBCHB (University of Edinburgh, Scotland) told TCTMD. “While if you have a scan and you see that you have the atheroma …
Jonathon Leipsic, MD (University of British Columbia / St. Paul’s Hospital, Canada), which was not involved in the study, agreed.
“There is relatively well accepted information that medical management focused on CT is led to better membership,” he told TCTMD. “This shows this in an asymptomatic population and I think that mechanically emphasizes why we would potentially see an improvement in results due to the titration of medical therapy based on the presence or absence of illness. I think that is quite important.”
The Scost-Heart 2 study, with plans to recruit around 6,000 patients at risk of cardiovascular disease, is designed to determine whether ACCT with ACCT is more effective than risk rating to guide not only the use of preventive therapies, but also reduce the risk of myocardial infarction. The study follows ScotlersA historical trial that has shown the use of CCTA in patients with chest pain has reduced the risk of myocardial death and infarction over 5 years compared to standard care.
CCTA in primary prevention
For the analysis, published Online last week in Jama cardiologyMcDermott and his colleagues included 400 known MCV participants (62 years of 62 years; 49.5%) registered in Scoss-Heart 2 which were randomized for a rating of cardiovascular risks (n = 195) or CCTA (n = 205) between September 2020 and January 2024. Median median at 10 years risk. Among those who received the CCTA, 49% had normal coronary arteries, 42% had non -obstructive disease and 9% had obstructive disease.
At 6 months, those assigned to the CCTA were more likely than those of the CV risk score group to comply with the National Institute for Health and Care Excellence (Nice) for diet, BIR, smoking and physical exercise (17% vs 6%; or 3.42; 95% CI 1.63-6.94). This was motivated by significantly higher rates of achieving a healthy BMI and compliance with food advice.
In addition, less preventive treatment was proposed after CCTA (51% against 75%), but patients more easily accepted treatment recommendations (77% vs 46%; P <0.001 for both). This resulted in similar use of lipididentic therapy (35% vs 44%; P = 0.08), but antiplatelet therapy has been used more often after CCTA (40% vs 0.5%; P <0.001).
ACTA guided management has also translated as risk factors improvements such as weight, BMI, waist, APP PA, average blood pressure, total cholesterol, LDL cholesterol and number of steps, with greater progress among people with coronary atheroma defined by CT.
Finally, at 6 months, the cardiovascular risk score at 10 years increased from 13% to 11% in the CCTA group (P <0.001), but no change of this type was observed in the risk score arm.
Until we have randomized clinical trial data, I would probably be a little careful to make solid recommendations at the moment and where we should use CT angiography. Michael McDermott
“A painting painted a thousand words,” said McDermott, explaining the probable reasoning behind their results and how they are probably generalizable to the populations outside of Scotland. “The presence of a coronary disease on CT angiography transcends all linguistic barriers. It allows patients to understand their own personalized and individual risk and not the risk of the population. ”
He took care to emphasize that this is not a study of all countries Population screening program Just again.
“In the end, we must see what the main SCOT-HEART 2 study reveals,” said McDermott. “We must understand where the greatest risk reduction is, if we see a risk reduction in coronary artery events … until we have randomized clinical trial data, I would probably be a little careful to make solid recommendations at the moment and where we must use the CT angiography.”
For Leipsic, the analysis does not answer a critical question: should CT angiograms be carried out in patients who are well without symptoms? This also does not give an overview of how the APPTA works as a motivation tool compared to the notation of calcium, “which is increasingly used in this population,” said Leipsic. However, when the test results are available, this information is useful for patients and doctors.
“This is just a new reminder that the richness of CT helps to illuminate medical management, helps to empower conversation and empower the patient, and stimulates greater membership and more to adopt medical therapy,” he said.
In an accompanying editorialPamela S. Douglas, MD, and Neha J. Pagidipati, MD (Duke University, Durham, NC), encourage doctors to keep the course, while keeping the CCTA in mind.
“In the end, we can continue to do what we have always done: provide preventive recommendations based on calculated risk scores,” they write. “But if most patients and their clinicians are not sufficiently motivated by these scores to make changes in lifestyle or prescribe preventive therapies, what is the interest?” The study, they add, provides “convincing data that ACCT and screening for subclinical atherosclerosis in general can help us cross the last kilometer to prevent the ASCVD effectively.”