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Visualising arteries may be ‘wake-up call’ to change lifestyle

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Looking at images of their own calcified coronary arteries may be a wake-up call for patients with newly-diagnosed coronary artery disease to change lifestyle, suggests Danish research.

Patients who looked at images were more likely to stop smoking, lose weight and take statins, according to a study by Rikke Elmose Mols, a nurse and PhD student at Aarhus University Hospital-Skejby.

Ms Mols said: “Until now there has not been a study on the impact of showing consecutive patients with atypical angina images of their calcified coronary arteries as a way to stimulate change.”

The aim of the study was to assess the influence of visualisation of coronary artery calcification in addition to standard information about risk and lifestyle modification on plasma cholesterol concentrations and other risk factors in patients with hyperlipidaemia and a new diagnosis of non-obstructive coronary artery disease.

The study included 189 patients with hyper-lipidaemia who had undergone a computed tomography angiography (CTA) of their coronary arteries and been diagnosed with non-obstructive coronary artery disease.

“Visualising their health threat motivates patients to make changes to reduce their risk”

Rikke Elmose Mols

Patients were randomised to the intervention or to standard follow up in general practice, which consisted of information about risk and lifestyle modification. Risk factors were measured at baseline and six months.

The intervention was a 25-minute consultation with a nurse. The first 15 minutes focused on communication of risk. Patients were shown a CT image of their calcified coronary arteries. The nurse explained the association between coronary artery calcification and the increased risk of future adverse cardiovascular events.

The nurse also described the relationship between CVD risk factors and the development of coronary artery calcification. Ten minutes were then devoted to giving advice about statins, aspirin, blood pressure, healthy diet, physical activity and smoking cessation.

After excluding patients who discontinued statin therapy due to side effects, the researchers found a significantly greater reduction in plasma total cholesterol concentrations in the intervention group compared to controls – 1.71 mmol/L versus 1.44 mmol/L.

More patients in the control group continued smoking – 22% versus 9% – and eating an unhealthy diet – 64% versus 44%. The intervention group lost 1.5kg on average while the control group gained an average of 0.5kg. There was a tendency towards a higher degree of adherence to statin therapy in the intervention group, added the authors.

Ms Mols said: “Seeing their calcified coronary arteries on the CT image was clearly an eye-opener for patients. We received comments such as, ‘It is my coronary artery and my coronary artery calcification and I am facing a real risk and challenge’.

“This may be the wake-up call patients need to take their medication and modify their behaviours to reduce their risk of having a coronary artery event,” she said.

She added: “The results of our study suggest that visualising their health threat motivates patients to make changes to reduce their risk. A large-scale study is needed to confirm the findings and to determine the cost-effectiveness of implementing this intervention in clinical practice.”

The study was presented at the EuroHeartCare conference, the annual meeting of the Council on Cardiovascular Nursing and Allied Professions of the European Society of Cardiology.

The 2015 meeting is being held from 14-15 June in Dubrovnik in Croatia.

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