A randomized clinical trial found that more lipid-lowering medications were prescribed when physicians were provided with pictorial information about the carotid plaques and the vascular age of patients. These findings were published in JAMA Network Open.

The Visualization of Asymptomatic Atherosclerotic Disease for Optimum Cardiovascular Prevention (VIPVIZA) study invited residents of Västerbotten County in Sweden to be screened for cardiovascular disease (CVD) risk factors at 40, 50, and 60 years of age. Participants in the program between 2013 and 2016 who had low CVD risk (N=4177) underwent a carotid ultrasonographic examination. Participant’s primary care physicians were randomized in a 1:1 ratio to receive pictorial results of the scan which depicted vascular age, carotid intima-media thickness, and carotid plaques. Prescribed medications through day 465 after examination were assessed.

Participants were 52.9% women, 64.5% were aged 60 years, 27.7% 50 years, and 7.8% 40 years.


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Stratified by gender, more men (42.2% vs 28.2%) had high blood pressure (>140/90 mm Hg; P <.001) and were receiving antihypertensive drugs (39.2% vs 24.4%; P =.003) and more women had high total cholesterol (mean, 220 vs 213 mg/dL; P <.001) but fewer women (12.8% vs 19.9%; P <.001) were on lipid-lowering medications.

After receiving the pictorial information, more men (18.5% vs 5.5%; P <.001) and more women (15.5% vs 4.7%; P <.001) were prescribed lipid-lowering drugs compared with controls, respectively. All but 2 of these new prescriptions were for statins.

Receiving the pictorial information did not increase new antihypertensive medication prescriptions among men (12.0% vs 10.6%; P =.47) or women (9.8% vs 10.4%; P =.73) compared with controls, respectively.

Among the intervention cohort, new prescriptions for lipid-lowering medications associated with serum cholesterol >250 mg/dL (odds ratio [OR], 5.20; 95% CI, 3.09-8.76), presence of carotid plaques (OR, 3.77; 95% CI, 2.73-5.22), diabetes (OR, 2.34; 95% CI, 1.19-4.60), antihypertensive mediation at baseline (OR, 1.63; 95% CI, 1.18-2.25), and older vascular age than chronological age (OR, 1.57; 95% CI, 1.08-2.29).

Receiving antihypertensive medications associated with blood pressure ³140/90 mmHg (OR, 6.82; 95% CI, 4.40-10.58) and older vascular age than chronological age (OR, 2.32; 95% CI, 1.48-3.64).

This study may have been limited, as data about prescriptions outside of the Region were not available for this study.

These data indicated that pictorial information about vascular age and carotid plaques provided to primary care physicians affected their decision to dispense lipid-lowering drugs but not antihypertensive medications.

Reference

Sjölander M, Carlberg B, Norberg M, Näslund U, Ng N. Prescription of Lipid-Lowering and Antihypertensive Drugs Following Pictorial Information About Subclinical Atherosclerosis: A Secondary Outcome of a Randomized Clinical Trial. JAMA Netw Open. 2021;4(8):e2121683.