A Picture is Worth a Thousand Words… and Your Heart!

‘Cardiovascular prevention’ is basically a fancy term for the following:

  • Start exercising
  • Lose weight
  • Stop smoking
  • Eat healthy
  • Check your BP and cholesterol and treat if abnormal

Despite how simple it sounds, it turns out that behavioral modification is really hard to achieve. Cardiovascular professional organizations and health authorities around the world endorse numerous evidence-based recommendations for the screening, prevention, and management of heart disease. However, a significant gap persists between the evidence-based recommendations and their implementation. The problem may lie at several levels, including physicians and patients.

The authors of this recent study from Sweden proposed an innovative way to foster positive health behaviors to decrease risk for heart disease. Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA) is a pragmatic, open-label, randomised controlled trial in which individuals aged 40, 50, or 60 years with one or more conventional risk factors were eligible to participate. Participants underwent clinical examination, blood sampling, and ultrasound assessment of the carotid artery (a big artery in the neck supplying blood to the brain). Ultrasound assessment of the carotid artery can provide visual information about plaque formation, providing information about risk for stroke and heart disease.

Participants were randomly assigned to an intervention group (pictorial representation of carotid ultrasound plus a nurse phone call to confirm understanding) or a control group (not informed). The primary outcomes included scores obtained on 2 risk scoring systems to assess risk for heart disease – called the Framingham risk score (FRS) and European systematic coronary risk evaluation (SCORE) and these were assessed after 1 year among participants who were followed up.


picture ultrasound

The investigators enrolled 3532 individuals between April, 2013, and June, 2016, of which 1783 were randomly assigned to the control group and 1749 were assigned to the intervention group. At the end of 1 year, this trial, targeting both physicians and individuals, 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. This beneficial effect was demonstrated for both FRS and SCORE and for total and LDL cholesterol.

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. There is a critical need and a major opportunity to improve population outcomes by means of better implementation of proven strategies for prevention of heart disease.  The authors of this study should be lauded for proposing an easy-to-implement strategy that works – and lays the foundation for testing other similar strategies that leverage disease-oriented interventions.

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