AI Article Synopsis

  • - The trial explores whether using coronary computed tomography angiography (CCTA) is more effective than traditional cardiovascular risk scoring for managing lipid levels to prevent coronary artery disease (CAD) in asymptomatic individuals.
  • - About 3,400 middle-aged participants will be randomly assigned to two groups: one receiving usual care based on traditional risk scores and the other guided by CCTA results, with both requiring lifestyle changes and monitoring of blood pressure and glucose.
  • - The primary focus is on the percentage of participants taking lipid-lowering medication regularly after 6 and 12 months, while secondary outcomes include LDL cholesterol targets and barriers to treatment adherence.

Article Abstract

Background: Lipid management based on cardiovascular risk level is the cornerstone of primary prevention of coronary artery disease (CAD), while the accuracy and adherence of traditional cardiovascular risk stratification have been questioned. Prevention strategies based on imaging screening for atherosclerotic plaques are found to be more objective and adherent in recent studies. This trial aims to investigate the role of coronary computed tomography angiography (CCTA) in guiding the primary prevention of CAD in a randomized controlled design.

Methods: Approximately 3400 middle-aged asymptomatic community participants will be recruited and randomized in a 1:1 ratio to a traditional cardiovascular risk score-guided (usual care group) or CCTA-guided (CCTA group) strategy. Participants with cardiovascular disease, prior lipid-lowering therapy, CCTA contraindication, or serious diseases that affect life span will be excluded. The intervention strategy includes blood pressure, blood glucose, and lipid management and lifestyle modifications. Blood pressure and glucose targets and lifestyle modification recommendations keep the same in both strategies, while lipid management is personalized based on traditional risk level or CCTA results, respectively. The primary outcome is the proportion of participants taking lipid-lowering medication regularly at both 6 and 12 months. The secondary outcomes include the proportion of participants achieving low-density lipoprotein cholesterol lowering targets at 12 months, mean changes in lipid levels from baseline to 12 months, barriers to adherence, adverse reactions related to CCTA examination, and cardiovascular events.

Discussion: The study is the first randomized clinical trial to examine the effectiveness of a CCTA-guided versus a traditional risk score-guided primary prevention strategy in an asymptomatic community-based population.

Trial Registration: ClinicalTrials.gov NCT05725096. Registered on 2 February 2023.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11440714PMC
http://dx.doi.org/10.1186/s13063-024-08469-zDOI Listing

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