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The beneficial effect over 3 years by pictorial information to patients and their physician about subclinical atherosclerosis and cardiovascular risk: results from the VIPVIZA randomized clinical trial
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. (Arcum)ORCID iD: 0000-0003-2475-7131
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. (Arcum)ORCID iD: 0000-0003-0556-1483
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
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2021 (English)In: American Journal of Preventive Cardiology, ISSN 2666-6677, Vol. 7, article id 100199Article in journal (Refereed) Published
Abstract [en]

Objective: Non-adherence to guidelines and preventive measures is a major challenge, particularly so to ob- tain long-term adherence to lifestyle changes and recommended medication. The objective was to investigate if pictorial information regarding subclinical carotid atherosclerosis provided to individuals and physicians gave sustained effects on cardiovascular risk beyond the previously reported effect after 1 year and up to 3 years. 

Methods: A Prospective Randomized Open Blinded End-point (PROBE) trial. Within a CVD prevention program in Västerbotten County, Sweden, 3532 healthy individuals aged 40, 50 or 60 years were enrolled and 1:1 ran- domized to intervention ( n = 1749; pictorial information with additional prevention materials to participants and physicians) or control group ( n = 1783; no pictorial information to participants and physicians). Preventive measures were managed within primary care. Participants were investigated at baseline during 2013–2016 and at follow-up after 1 and 3 years. 

Results: A beneficial effect on cardiovascular risk was observed at 3-year follow-up; Framingham Risk Score (FRS) was 13.38 for the intervention group and 14.08 for the control group ( p = 0.047) and SCORE was 1.69 vs. 1.82 ( p = 0.022). The effect observed at 1-year was sustained over 3 years after adjustment for sex and education and more pronounced among participants with a severe atherosclerotic picture at baseline.

Conclusions: This study provides evidence of sustained beneficial effects on the adherence to prevention guidelines over 3 years of pictorial information about subclinical carotid atherosclerosis, resulting in lower cardiovascular risk regardless of sex and educational level. Direct visualization of the underlying still subclinical atherosclerotic disease, rather than just indirect information about risk factors and statistical risk of future myocardial infarction, stroke and death, is one way to tackle the problem of non-adherence to prevention of cardiovascular diseases.

Place, publisher, year, edition, pages
Elsevier, 2021. Vol. 7, article id 100199
Keywords [en]
Atherosclerosis, Cardiovascular disease, Carotid ultrasound, Prevention
National Category
Public Health, Global Health, Social Medicine and Epidemiology Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:umu:diva-186686DOI: 10.1016/j.ajpc.2021.100199ISI: 000906609200009PubMedID: 34611639Scopus ID: 2-s2.0-85130772460OAI: oai:DiVA.org:umu-186686DiVA, id: diva2:1585776
Note

Originally included in thesis in manuscript form.

Available from: 2021-08-18 Created: 2021-08-18 Last updated: 2024-07-02Bibliographically approved
In thesis
1. Pictorial presentation of subclinical atherosclerosis: a measure to reduce the risk for cardiovascular disease
Open this publication in new window or tab >>Pictorial presentation of subclinical atherosclerosis: a measure to reduce the risk for cardiovascular disease
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Visualisering av subklinisk ateroskleros : en metod för att minska risken för hjärt-kärlsjukdom
Abstract [en]

The overall aim was improved cardiovascular disease (CVD) prevention through the VIPVIZA intervention. This includes the provision of pictorial information of subclinical atherosclerosis to participants and their general practitioners (GPs), follow-up phone call, and written information to the participant. VIPVIZA is a Prospective Randomized Open Blinded End-point (PROBE) trial nested within VIP, a CVD prevention program in primary health care in Västerbotten county, Sweden. Middle-aged individuals at low/intermediate CVD risk were enrolled to VIPVIZA and randomized 1:1 to an intervention (n=1749) or control group (n=1783 who received no pictorial or other information). Preventive measures were managed within primary health care.

At baseline, clinical risk factors were measured and carotid ultrasound examination was performed. The prevalence of subclinical atherosclerotic disease was assessed as intima media thickness and presence of plaque. The association between clinical risk factors and measures of subclinical atherosclerosis was investigated. In addition to conventional risk factor-based risk evaluation, the impact of the VIPVIZA intervention on CVD risk, traditional risk factors and pharmacological treatment was evaluated after 1 and 3 years. Individual interviews were conducted with 15 GPs to explore how a pictorial representation of subclinical atherosclerosis affects physicians in their perception and communication of CVD risk. The interviews were analyzed by qualitative content analysis.

The plaque prevalence was 44.7% in this population. Clinical risk factors explained more of the variation in a combined ultrasound measurement than single measurements. The results up to three years showed a VIPVIZA intervention effect, with lower and sustained CVD risk in the intervention as compared to the control group. The effect was partly mediated by differences in intake of lipid-lowering medication and partly by lifestyle behaviour. The GPs described their risk assessment and patients’ risk perception as more accurate with the VIPVIZA intervention. Informing patients about examination results prior to a consultation can facilitate shared decision-making and enhance adherence to preventive measures.

The results show that the VIPVIZA intervention reduces CVD risk over three years. In the long run this has the potential to reduce the incidence of CVD events.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2021. p. 85
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2144
Keywords
Cardiovascular disease, non-adherence, pictorial information, prevention, subclinical atherosclerosis
National Category
Public Health, Global Health, Social Medicine and Epidemiology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-186699 (URN)978-91-7855-593-2 (ISBN)978-91-7855-592-5 (ISBN)
Public defence
2021-09-17, Zoom, Umeå, 09:00 (Swedish)
Opponent
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Zoom: https://umu.zoom.us/j/63352946259?pwd=MU5rVTdUZG1rMzVNTkIxaTl1czB1QT09 Password: 838770

Available from: 2021-08-27 Created: 2021-08-18 Last updated: 2024-07-02Bibliographically approved

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Bengtsson, AnnaNorberg, MargaretaNg, NawiCarlberg, BoGrönlund, ChristerHultdin, JohanLindahl, BerntNordin, StevenNyman, EmmaWennberg, PatrikWester, PerNäslund, Ulf

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Bengtsson, AnnaNorberg, MargaretaNg, NawiCarlberg, BoGrönlund, ChristerHultdin, JohanLindahl, BerntNordin, StevenNyman, EmmaWennberg, PatrikWester, PerNäslund, Ulf
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Family MedicineDepartment of Epidemiology and Global HealthSection of MedicineRadiation PhysicsClinical chemistrySection of Sustainable HealthDepartment of PsychologyCardiology
Public Health, Global Health, Social Medicine and EpidemiologyCardiac and Cardiovascular Systems

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