Lipid-Lowering Prescriptions Increase After Carotid Ultrasonography

Pictorial data on carotid intima-media thickness and presence of carotid plaques can improve prescription of lipid-lowering drugs.

Although ultrasonographic examinations can detect carotid plaque and increased carotid intima-media thickness (cIMT) and aid in estimation of the likelihood of cardiovascular disease (CVD), there is limited evidence from trials on the use of pictorial information.

A recent analysis of the Visualization of Asymptomatic Atherosclerotic Disease for Optimum Cardiovascular Prevention (VIPVIZA) assessed if the proportion of patients with asymptomatic atherosclerosis with a first prescription of lipid-lowering or antihypertensive drugs varied between intervention and control groups in 465 days post-carotid ultrasonography examination.

Study results from the trial showed the physician prescriptions of lipid-lowering, but not antihypertensive, drugs were higher in the following 465 days, if both patients and physicians were provided with pictorial information based on the results of ultrasonographic examination.

Methods

Investigators, led by Maria Sjölander, PhD, Department of Integrative Medical Biology, Umeå University, analyzed the VIPVIZA, a randomized clinical trial within the Västerbotten Intervention Program (VIP). The VIP was a CVD screening and prevention program that included 60 - 70% participation rates in Sweden.

Patients from the VIP were invited to enroll in the subsequent VIPVIZA if they met inclusion criteria from April 2013 - June 2016. Inclusion criteria included aged 40 years and first-degree relative with a history of CVD at an age less than 60 years, aged 50 years and ≥1 designated risk factor (smoking, diabetes, hypertension), or age 60 years.

Individuals who participated in VIPVIZA underwent a carotid ultrasonographic examination, but did not receive information on results during the same time period. Participants were assigned 1:1 to receive or not receive pictorial information from carotid ultrasonographic determination of vascular age.

The intervention consisted of information sent to both patient and physician within the following 2 weeks after examination, with pictorial information to indicate plaque or no plaque.

As well, a gauge indicated vascular age, based on the patient cIMT in comparison to cIMT of patients with similar demographics in the reference population. A follow-up call from a VIPZIA nurse assessed if patients understood the results properly.

Data analysis took place from December 2019 - April 2020.

Results

A total of 4177 individuals aged 40, 50, or 60 years were invited to enroll, with 3532 participants then randomized and included in the analysis.

Of this number, 1870 (52.9%) were women, 2278 (64.5%) were aged 60 years, while 978 (27.7%) were 50 years and 276 (7.8%) were 40 years.

Data show a larger proportion of men had a blood pressure level ≥140/90 mm Hg (42.2% versus 28.2%; P <.001) and a prescription for an antihypertensive drug at baseline (39.2% versus 34.4%; P = .003).

Investigators observed the number of first prescriptions of lipid-lowering drugs were higher in the intervention group (118 of 639, 18.5%) compared to the control group (38 of 692, 5.5%) in men, all P <.001.

In addition, they observed the same was true in women in the intervention group (126 of 814; 15.5%) in comparison to the intervention group (38 of 817, 4.7%, all P <.001.

No significant differences was found in the proportion with prescription of antihypertensive drugs in the intervention versus control groups after ultransonography in both men (12.0% versus 10.6%, P = .47) and women (9.8% versus 10.4%, P = .73)..

Following stratification for plaque, the proportion of first prescription for lipid-lowering drug was higher in the intervention group compared with control in patients with plaque for men (29.5% versus 6.7%; P <.001) and women (27.9% versus 5.9%; P <.001).

No significant difference in prescriptions of antihypertensive drugs were found after stratification for plaque in both men and women.

Conclusion

“To our knowledge, this is the first randomized clinical trial on the effect of pictorial information from carotid ultrasonographic screening on the prescription of lipid-lowering and antihypertensive drugs in individuals with subclinical atherosclerosis,” investigators wrote.

The team concluded the prescription of lipid-lowering, but not anti-hypertensive drugs increased in both patient and physician received pictorial information about carotid plaque and vascular age following ultrasonography findings.

The study, “Prescription of Lipid-Lowering and Antihypertensive Drugs Following Pictorial Information About Subclinical Atherosclerosis A Secondary Outcome of a Randomized Clinical Trial,” was published online in JAMA Network Open.