Verma Kunal P, Marwick Thomas H, Duarte Carla, Meikle Peter, Inouye Mike, Carrington Melinda J
Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
Am Heart J. 2022 Jun;248:97-107. doi: 10.1016/j.ahj.2022.02.007. Epub 2022 Feb 24.
The traditional primary prevention paradigm for coronary artery disease (CAD) centers on population-based algorithms to classify individual risk. However, this approach often misclassifies individuals and leaves many in the 'intermediate' category, for whom there is no clear preferred prevention strategy. Coronary artery calcium (CAC) and polygenic risk scoring (PRS) are 2 contemporary tools for risk prediction to enhance the impact of effective management.
To determine how these CAC and PRS impact adherence to pharmacotherapy and lifestyle measures in asymptomatic individuals with subclinical atherosclerosis.
The CAPAR-CAD study is a multicenter, open, randomized controlled trial in Victoria, Australia. Participants are self-selected individuals aged 40 to 70 years with no prior history of cardiovascular disease (CVD), intermediate 10-year risk for CAD as determined by the pooled cohort equation (PCE), and CAC scores >0. All participants will have a health assessment, a full CT coronary angiogram (CTCA), and PRS calculation. They will then be randomized to receive their risk presented either as PCE and CAC, or PCE and PRS. The intervention includes e-Health coaching focused on risk factor management, health education and pharmacotherapy, and follow-up to augment adherence to a statin medication. The primary endpoint is a change in low-density lipoprotein cholesterol (LDL-C) from baseline to 12 months. The secondary endpoint is between-group differences in behavior modification and adherence to statin pharmacotherapy.
As of July 31, 2021, we have screened 1,903 individuals. We present the results of the 574 participants deemed eligible after baseline assessment.
冠状动脉疾病（CAD）的传统一级预防模式以基于人群的算法对个体风险进行分类为核心。然而，这种方法常常对个体进行错误分类，使许多人处于“中等风险”类别，而对于这类人群，没有明确的首选预防策略。冠状动脉钙化（CAC）和多基因风险评分（PRS）是两种用于风险预测的现代工具，以增强有效管理的效果。
确定CAC和PRS如何影响无症状亚临床动脉粥样硬化个体对药物治疗和生活方式措施的依从性。
CAPAR-CAD研究是在澳大利亚维多利亚州进行的一项多中心、开放、随机对照试验。参与者为年龄在40至70岁之间、无心血管疾病（CVD）既往史、根据合并队列方程（PCE）确定的CAD 10年风险为中等且CAC评分>0的自我选择个体。所有参与者将进行健康评估、完整的CT冠状动脉造影（CTCA）以及PRS计算。然后他们将被随机分组，以PCE和CAC或PCE和PRS的形式告知其风险。干预措施包括专注于风险因素管理、健康教育和药物治疗的电子健康指导，以及随访以增强对他汀类药物治疗的依从性。主要终点是从基线到12个月时低密度脂蛋白胆固醇（LDL-C）的变化。次要终点是行为改变和他汀类药物治疗依从性的组间差异。
截至2021年7月31日，我们已筛查了1903名个体。我们展示了在基线评估后被认为符合条件的574名参与者的结果。
