Impact of Carotid Plaque Screening on Smoking Cessation and Other Cardiovascular Risk Factors: A Randomized Controlled Trial

Study Questions:

What is the clinical impact of carotid plaque screening on helping smokers to improve their health behaviors and cardiovascular risk factors?

Methods:

The investigators randomly assigned 536 smokers, ages 40-70 years, to carotid plaque ultrasonographic screening (US group) versus no screening (control group), in addition to individual counseling and nicotine replacement therapy for all participants. Smokers with at least one plaque received pictures of their plaques, along with a 7-minute structured explanation. The outcomes included biochemically validated smoking cessation at 12 months (primary outcome) and changes in cardiovascular risk factor levels and Framingham risk score.

Results:

At baseline, participants (mean age, 51.1 years; 45.0% women) smoked an average of 20 cigarettes per day, with a median duration of 32 years. The US group had a high prevalence of carotid plaques (57.9%). At 12 months, smoking cessation rates were high, but did not differ between the US and control groups (24.9% vs. 22.1%; p = 0.45). In the US group, cessation rates did not differ according to the presence or absence of plaques. Control of cardiovascular risk factors (i.e., blood pressure and low-density lipoprotein cholesterol and hemoglobin A1c levels in diabetic patients) and mean absolute risk change in Framingham risk score did not differ between the groups. The mean absolute risk change in Framingham risk score was +0.6 in the US group vs. +0.3 in the control group (p = 0.56).

Conclusions:

The authors concluded that in smokers, carotid plaque screening performed in addition to thorough smoking cessation counseling is not associated with increased rates of smoking cessation or control of cardiovascular risk factors.

Perspective:

This study suggests that carotid plaque screening by means of ultrasound was not associated with increased smoking cessation or better control of cardiovascular risk factors after 12 months when added to comprehensive individual counseling and use of nicotine replacement therapy products. These findings are important, given the increasing use of such screening in clinical practice. Until additional compelling data are available, atherosclerosis screening in asymptomatic patients should not be generally recommended. Future studies should also evaluate whether atherosclerosis screening may be helpful among smokers who undergo less intense smoking counseling or to refine cardiovascular risk estimates to more optimally target preventive medications.

Clinical Topics: Dyslipidemia, Lipid Metabolism, Nonstatins

Keywords: Hemoglobin A, Nicotine, Atherosclerosis, Plaque, Atherosclerotic, Lipoproteins, Risk Factors, Tobacco Use Cessation Products, Cholesterol, Prevalence, Cardiology, Cardiovascular Diseases, Tobacco Use Disorder, Smoking Cessation


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