Department of Cardiology, Lillebaelt Hospital-Vejle, Vejle, Denmark.
Department of Cardiology, Aarhus University Hospital-Skejby, Aarhus, Denmark.
Am J Med. 2015 Sep;128(9):1023.e23-31. doi: 10.1016/j.amjmed.2015.03.033. Epub 2015 Apr 22.
Direct health provider to patient presentation of coronary computed tomography angiography findings may increase adherence to preventive therapy and risk modification. The purpose of this study was to assess the influence of visualization of coronary artery calcification and lifestyle recommendations on cholesterol concentrations and other risk variables in symptomatic patients with nonobstructive coronary artery disease and hyperlipidemia.
We performed a prospective 2-center randomized controlled trial. Patients were randomized 1:1 to intervention or standard follow-up in general practice. The primary end point was change in plasma total cholesterol concentration at 6 months follow-up.
We included 189 patients (mean [± standard deviation] age 61 [12] years, 57% were male). Median (range) Agatston score was 166 (70-2054). The reduction in plasma total cholesterol concentrations tended to be higher in the intervention group than in the control group, 51.04 mg/dL versus 45.63 mg/dL (P = .181). In a subgroup including patients continuing statin therapy during follow-up (n = 147), the reduction in plasma total cholesterol concentrations was more pronounced in the intervention group than in the control group, 66.13 mg/dL versus 55.68 mg/dL (P = .027). In the intervention group, there was a higher degree of statin adherence and a higher proportion of patients who stopped smoking and commenced healthier dietary behavior than in the control group.
Visualization of coronary artery calcification and brief recommendations about risk modification after coronary computed tomography angiography in symptomatic patients with nonobstructive coronary artery disease and hyperlipidemia may have a favorable influence on plasma total cholesterol concentration, adherence to statin therapy, and risk behavior. Further investigations are needed.
直接向医疗保健提供者展示冠状动脉 CT 血管造影检查结果可能会增加预防性治疗和风险改变的依从性。本研究旨在评估在有非阻塞性冠状动脉疾病和高脂血症的症状性患者中，可视化冠状动脉钙化和生活方式建议对胆固醇浓度和其他风险变量的影响。
我们进行了一项前瞻性的 2 中心随机对照试验。患者按 1:1 随机分配到干预组或普通实践中的标准随访组。主要终点是 6 个月随访时血浆总胆固醇浓度的变化。
我们纳入了 189 名患者（平均[±标准差]年龄 61[12]岁，57%为男性）。中位数（范围）的 Agatston 评分是 166（70-2054）。干预组的血浆总胆固醇浓度降低趋势高于对照组，分别为 51.04mg/dL 和 45.63mg/dL（P=0.181）。在包括在随访期间继续服用他汀类药物的患者的亚组（n=147）中，干预组的血浆总胆固醇浓度降低更为显著，分别为 66.13mg/dL 和 55.68mg/dL（P=0.027）。在干预组中，他汀类药物的依从性更高，停止吸烟和开始更健康饮食行为的患者比例也更高。
在有非阻塞性冠状动脉疾病和高脂血症的症状性患者中，冠状动脉 CT 血管造影后可视化冠状动脉钙化并简要建议进行风险改变可能对血浆总胆固醇浓度、他汀类药物治疗的依从性和风险行为有有利影响。需要进一步的研究。
