Utilizing existing test results to improve primary prevention in patients with subclinical coronary atherosclerosis:...

The systematic referral of patients with incidentally detected subclinical coronary atherosclerosis to a specialized prevention clinic is an innovative strategy in Europe. The USE-IT study aims to assess its impact in terms of 12-month change in low-density lipoprotein cholesterol (LDL-C) levels.

Prospective, non-randomized study (N = 291). Patients were referred after incidental detection of subclinical coronary atherosclerosis through a clinically indicated cardiac/coronary computed tomography (CT) (29%), invasive coronary angiography (24%), or chest CT (44%). Cardiovascular risk-reduction interventions were implemented following relevant guidelines.

Mean age was 66 years, 43% women. The prevalence of traditional risk factors was high, 38% of the patients had atherosclerosis in ≥3 coronary arteries, 33% had at least one stenosis ≥50% and 60% had an elevated CAC score (≥300 UA). Mean baseline LDL-C levels were 108 mg/dL (SD 37), 16% had LDL-C <70mg/dL, and 6% had LDL-C <55mg/dL. At 12 months there were marked increases in the use of high-intensity statins (28% vs 78%, p < 0.001) and ezetimibe (7% vs 69%, p < 0.001). At the end of follow-up, mean LDL-C levels were 61 mg/dL (p < 0.001), 76% participants had LDL-C <70mg/dL (p < 0.001), and 49% <55mg/dL (p < 0.001). Among smokers, 15% of them successfully quit tobacco during follow-up, and obesity prevalence went from 34% to 29% (p = 0.002).

Systematic referral of patients with incidentally detected subclinical coronary atherosclerosis to a specialized prevention clinic and subsequent guideline-based risk management provides an innovative opportunity to achieve large, guideline-recommended reductions in LDL-C and enhance the management of other risk factors.

This research study was performed to assess whether a specialized, dedicated cardiovascular prevention clinic could help lower the levels of "bad" cholesterol (LDL-C) and improve the management of other cardiovascular risk factors in people who, despite feeling well, already have fatty plaques building up in their heart's arteries. Such men and women are at increased risk of heart attacks and strokes, however, so far they had received very limited attention in prevention clinics and primary care settings, particularly when those plaques are identified incidentally. Reducing their levels of bad cholesterol can be very helpful reducing their risk of a subsequent heart attack. Specifically, at twelve months, we observed:• Large reductions in the levels of bad cholesterol compared to the levels that those same patients had at the beginning of follow-up (i.e., before being referred to the prevention clinic), paired with enhanced use of guideline-recommended lipid-lowering pharmacological therapies.• A reduction in the prevalence of active smoking, and a modest but promising reduction in the average weight of the cohort.The results of the "USE-IT" Study are expected to inform the development of similar clinics across Spain (the country where the study was conducted) and elsewhere.