CT Angiography, Healthy Lifestyle Behaviors, and Preventive Therapy: A Nested Substudy of the SCOT-HEART 2 Randomized Clinical Trial.

Background

To determine the impact of coronary computed tomography (CT) angiography on healthy lifestyle behaviors, acceptance of recommended treatments, and modification of risk factors as compared with guideline-directed cardiovascular risk scoring.

确定冠状动脉计算机断层扫描（CT）血管造影对健康生活方式行为、推荐治疗的接受度以及风险因素的改变的影响，与指南指导的心血管风险评分进行比较。

DESIGN, SETTING, AND PARTICIPANTS: This was a nested substudy conducted from September 2020 to August 2024 of a randomized clinical trial where participants underwent cardiovascular risk scoring or coronary CT angiography.

这是一项嵌套的子研究，从2020年9月到2024年8月进行，基于一项随机临床试验，参与者接受了心血管风险评分或冠状动脉CT血管造影。

Primary care-based screening took place in Scotland.

初级保健筛查在苏格兰进行。

Included in the analysis were asymptomatic individuals aged 40 to 70 years without known cardiovascular disease and with at least 1 cardiovascular risk factor.

分析纳入了40至70岁之间无已知心血管疾病的无症状个体，且至少具有1个心血管风险因素。

Study data were analyzed from August to September 2024.

研究数据从2024年8月至9月进行了分析。

Methods

All participants received lifestyle advice with additional recommendations for moderate-intensity statin therapy if the 10-year cardiovascular risk was greater than or equal to 10% or combined antiplatelet and at least moderate-intensity statin therapies if coronary atherosclerosis was identified on CT angiography.

所有参与者接受了生活方式建议，并且如果10年心血管风险大于或等于10%，则额外推荐中等强度的他汀类药物治疗；如果CT血管造影显示冠状动脉粥样硬化，则推荐联合抗血小板和至少中等强度的他汀类药物治疗。

main_outcomes_and_measures

The composite primary outcome was compliance with the National Institute for Health and Care Excellence recommendations for diet, body mass index, smoking, and physical exercise at 6 months.

主要复合终点是在6个月内遵循国家卫生和护理卓越研究所关于饮食、体质指数、吸烟和体力活动的建议。

Results

Between September 2020 and January 2024, 400 participants were enrolled (median [IQR] age, 62 [56-65] years; 198 female [49.5%]; median [IQR] 10-year cardiovascular risk, 14% [9%-19%]) with 195 randomized to cardiovascular risk scoring and 205 to coronary CT angiography.

在2020年9月至2024年1月期间，共有400名参与者（中位年龄62岁，四分位数间距[56-65]；198名女性[49.5%]；10年心血管风险中位数[四分位数间距]为14%[9%-19%]）被纳入研究，其中195名被随机分配至心血管风险评分组，205名被随机分配至冠状动脉CT血管造影组。

At 6 months, those who underwent CT angiography were more likely to meet the primary composite end point (17% [33 of 194 participants] vs 6% [10 of 177 participants]; odds ratio, 3.42; 95% CI, 1.63-6.94; P < .001).

在6个月时，接受CT血管造影的参与者更有可能达到主要复合终点（17%[33/194参与者]对比6%[10/177参与者]；优势比为3.42；95%置信区间为1.63-6.94；P < .001）。

Compared with cardiovascular risk scoring, fewer participants were recommended preventive therapy after CT angiography (51% [105 of 205 participants] vs 75% [147 of 195 participants]; P < .001), but acceptance of recommendations was higher (77% [81 of 105 participants] vs 46% [68 of 147 participants]; P < .001).

与心血管风险评分相比，接受CT血管造影后推荐预防性治疗的参与者较少（51% [105/205] vs 75% [147/195]; P < .001），但接受推荐的比率更高（77% [81/105] vs 46% [68/147]; P < .001）。

This resulted in similar use of lipid-lowering therapy (44% [90 of 205 participants] vs 35% [69 of 195 participants]; OR, 1.43; 95% CI, 0.96-2.15; P = .08) and greater use of antiplatelet therapy in those randomized to CT angiography (40% [83 of 205 participants] vs 0.5% [1 of 195 participants]; P < .001).

这导致了类似使用降脂治疗（44% [90/205] vs 35% [69/195]; OR, 1.43; 95% 置信区间, 0.96-2.15; P = .08）和在随机接受CT血管造影的参与者中更大比例使用抗血小板治疗（40% [83/205] vs 0.5% [1/195]; P < .001）。

Participants randomized to coronary CT angiography had small incremental improvements in risk factors and 10-year cardiovascular risk, largely driven by those with CT-defined coronary atheroma.

随机分配到冠状动脉CT血管造影的参与者在风险因素和10年心血管风险方面有小幅增量改善，这主要由那些CT定义的冠状动脉粥样硬化患者所驱动。

conclusions_and_relevance

Results of this cohort study reveal that compared with cardiovascular risk scoring, coronary CT angiography was associated with modest improvements in healthier lifestyle behaviors, acceptance of recommended preventive therapy, and risk factor modification.

这项队列研究的结果显示，与心血管风险评分相比，冠状动脉CT血管造影与健康生活方式行为、接受推荐的预防治疗以及风险因素改善的适度提高相关。

Whether this strategy reduces coronary events remains to be established.

是否这种策略能减少冠状动脉事件，尚待确定。