Ultrasound-Based Visualization of Silent Atherosclerosis May Improve Medication Adherence

Carotid artery
Carotid artery
A simple intervention may contribute to the prevention of CVD and may improve medication adherence and lifestyle modification.

A visual representation of subclinical atherosclerosis based on carotid ultrasound as a low-intensity intervention contributes to the prevention of cardiovascular disease by motivating medication adherence and lifestyle changes, according to study results published in The Lancet.

The investigators of this randomized controlled study sought to examine whether providing both primary care physicians and individuals with ultrasound-based pictorial information about asymptomatic atherosclerosis in communicating risk of cardiovascular disease improves adherence to prevention guidelines.  

The study sample included 3532 individuals aged 40, 50, or 60 years who reported 1 or more conventional risk factors for cardiovascular disease; participants and their physicians were randomized to receive pictorial information of carotid ultrasound results plus a 2-week follow-up call from the research nurse to confirm understanding (n=1749) or no pictorial information (n=1783).

To measure risk factors for cardiovascular disease, the participants underwent clinical examination at baseline, had blood samples analyzed, and submitted to ultrasound examination of their carotid intima media wall thickness and plaque formation.

All participants were managed according to clinical guidelines for cardiovascular disease for the study duration and were followed for 1 year. The primary study outcomes were risk of cardiovascular disease measured with the Framingham risk score (FRS) and European systematic coronary risk evaluation (SCORE).

While 3175 participants completed the 1-year follow-up, there were no differences in baseline FRS or SCORE in dropouts and participants from either the intervention or control groups.

At the 1-year follow-up, intervention and control group outcomes differed significantly for both FRS (1.07; 95% CI, 0.11-2.03; P =.0017) and SCORE (0.16; 95% CI, 0.02-0.30; P =.001), favoring the intervention group.

FRS scores significantly decreased from baseline to follow-up in the intervention group by -0.58 (95% CI, -0.86 to -0.30), and increased in the control group by 0.35 (95% CI, 0.08-0.63).

Both groups had an increase in SCORE from baseline to follow-up, but this increase was significantly less for the intervention group (0.13; 95% CI, 0.09-0.18) compared with the control group (0.27; 95% CI, 0.23-0.30). Changes in risk assessment were similar between men and women, and an increase in SCORE was greater among older participants.

Analysis of intervention impact by risk category showed that individuals with basic to mid-level education and high risk of cardiovascular disease had the greatest reduction in scores. Furthermore, the intervention group had a significant increase in lipid-lowering medication adherence vs the control group.

A limitation to the study was that the only differences between dropouts and participants were observed in risk factors associated with lifestyle, education, and age. After adjusting for these factors, however, their effect on primary outcomes was not considered significant.

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The study findings provide evidence that ultrasound-based pictorial representation of subclinical atherosclerosis, plus a nurse-led follow-up call, reduced risk of cardiovascular disease after 1 year.

The investigators suggest that this low-intensity intervention may contribute to the prevention of cardiovascular disease and can improve medication adherence and lifestyle modification.


Näslund U, Ng N, Lundgren A, et al. Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA): a pragmatic, open-label, randomized controlled trial [published online December 3, 2018]. Lancet. doi:10.1016/S0140-6736(18)32818-6