Research in context
Evidence before this study
Physical activity, smoking cessation, and treatment of hypertension and hypercholesterolaemia are among the most effective, cost-effective, and evidence-based therapies for non-communicable diseases. However, prevention of cardiovascular disease fails, largely because of low adherence to guidelines and recommendations for lifestyle change and pharmacological treatment by individuals and health-care professionals. Risk assessment, risk communication, and motivation for a change in lifestyle are all targets to improve adherence to prevention measures. Pictorial representation of the risk factor burden might improve risk perception and motivation, but few studies have investigated this hypothesis, and no systematic reviews are published. Vascular ultrasound of atherosclerotic plaques and intima media wall thickness is an established diagnostic tool to assess atherosclerosis, but the effects on adherence to healthy lifestyle and drug therapy have not previously been studied in randomised controlled trials.
Added value of this study
This pragmatic, open-label, randomised controlled trial, targeting both physicians and individuals, aimed at improved efficacy and adherence to prevention measures in an asymptomatic population, showed significant benefits with respect to lowering the risk factor burden for cardiovascular disease in participants given a pictorial representation of their atherosclerotic plaques and intima media wall thickness, presented as vascular age, compared with participants who received routine care, with no pictorial information (Framingham risk score 1·07 [95% CI 0·11 to 2·03, p=0·0017] and systematic coronary risk evaluation [SCORE] 0·16 [0·02 to 0·30, p=0·0010]).
Implications of all the available evidence
This study provides further evidence on the contributory role of pictorial representations and dialogue about silent atherosclerosis for primary prevention of cardiovascular disease, which are valid for clinical practice. Whether the results are sustainable for more than 1 year and lead to reduction of cardiovascular disease events warrant long-term follow-up.