Time to initiation of lipid-lowering drugs for subclinical atherosclerosis: sub-study of VIPVIZA randomized controlled trial, with single-arm cross-over

Abstract

Background Visual information about subclinical atherosclerosis was provided to physicians and participants in the VIPVIZA trial, inclusion 2013 to 2016 in northern Sweden, aiming to improve adherence to cardiovascular disease (CVD) prevention guidelines. Pictorial risk information may be more actionable. Aim Investigate the effect of intervention with pictorial risk information on time to first dispensing of statins. Method Asymptomatic atherosclerotic disease was screened for by carotid ultrasound examination in 3532 participants enrolled in VIPVIZA, of those 3000 met the criteria for this study. Participants were randomly assigned to receive pictorial risk information consisting of graphical representation of atherosclerosis as compared to a control group without intervention. Time to initiation of statins was assessed during a five-year follow-up through the National prescribed drug register. After three years, both groups were re-examined and received the intervention information. Results In the intervention group, initiation of statins increased considerably for the first three years and a smaller increase was also seen after re-intervention. After the cross-over, the control group showed a sharp increase in initiation of statins, almost reaching the same proportion treated at 5 years. The propensity to initiate statin treatment increased over the study period and there was no difference between men and women. Conclusions The pictorial information had an effect on time to initiation of statins, both as original and repeated intervention and also in the control group after single arm cross-over. The current study supports pictorial information as a tool to shorten time to initiation of statins for CVD prevention. The VIPVIZA study is registered with ClinicalTrials.gov, number NCT01849575.

Improved adherence to statin treatment and differences in results between men and women after pictorial risk communication—a sub-study of the VIPVIZA RCT

“…Attached to the patient-related information to the physicians, guidelines for preventive treatment of patients with silent arthrosclerosis were also included. We have previously shown a clear increased rate of prescriptions of statins after the VIPIVZA intervention [ 11 , 29 ].…”

“…How this was experienced by and affected the participants was previously described [ 12 , 15 , 16 ]. How the intervention affects physicians’ prescriptions of statins and facilitates patient interaction and shortens time to initiation of statins has earlier been described [ 9 , 11 ]. In recent studies, the difference between men and women regarding both the patients’ and physicians’ view of CVD risk was highlighted.…”

“…The VIPVIZA interventions is personalised and includes colour-coded and age-related pictorial risk information based on the individual’s ultrasound examination of the carotid arteries and a follow-up motivational dialogue with a specially trained nurse. It has been previously studied how the intervention affect physicians and participants behaviours and outcomes and time to initiation of statins [ 8 – 11 ]. The most recently published results from VIPVIZA, with an example of the pictorial risk communication, timeline for the intervention and as supplement, a translation to English of the written information in the ultrasound report [ 12 ].…”

Reduced progression of carotid intima media thickness by personalised pictorial presentation of subclinical atherosclerosis in VIPVIZA—A randomised controlled trial

“…In a qualitative evaluation of physicians experiences from receiving the VIPVIZA ultrasound information it was shown that the consultation became more patient-centred (Bengtsson et al, 2021a). Further, in a recently published evaluation on the intervention effect on physicians time to initiation of statin showed that after 3 years the average intensity of statin therapy was tripled in the intervention group (Holmberg et al, 2022). Previous results from VIPIVZA has shown that the LDL-cholesterol levels was significantly decreased in the intervention group at 3-year follow-up emphasising that the reduced progression of cIMT could be an effect of intensified lipid lowering therapy.…”

Vascular changes that may affect the prognosis of patients and that could also be looked for by an internist, diabetologist, lipidologist or general practitioner

“…Tato hodnota je jistě dobrou motivací ke změně životního stylu pro asymptomatické pacienty s aterosklerózou. Přímá vizualizace plátu a jeho předvedení pacientovi během vyšetření pak značně zkrátí čas, nutný k diskuzi nad zahájením terapie, a výrazně zlepši adherenci k dietním i farmakologickým opatřením (21,22).…”