Compared with cardiovascular risk scoring, participants receiving coronary CT angiography (CCTA) were more likely to show improvement in healthier lifestyle behaviors, adherence with recommended preventive therapies and modification of risk factors, according to results from a substudy of the SCOT-HEART 2 trial published June 18 in JAMA Cardiology.

In this nested substudy, Michael McDermott, MBChB, et al., included 400 asymptomatic participants (median age 62 years, 50% women); 14% had a median 10-year cardiovascular risk, with ≥1 cardiovascular risk factor(s). All received primary care screening including healthy lifestyle advice and recommendations for statin therapy if 10-year risk was ≥10% or if atherosclerosis was present on CCTA. Antiplatelet therapy was also recommended to those in the CCTA group with atherosclerosis.

The primary outcome was achievement of all National Institute for Health and Care Excellence (NICE) recommendations regarding diet, BMI, smoking and exercise.

Results revealed that by six months, those who underwent CCTA (n=205) vs. risk scoring (n=195) were more likely to meet the primary endpoint (17% vs. 6%, respectively; odds ratio, 3.42; 95% CI, 1.63-6.94; p<0.001). Notably, diet compliance (47% vs. 36%) and BMI improvement (31% vs. 21%) were higher with CCTA, with no differences in smoking status or self-reported physical activity.

Other findings showed that although fewer participants were recommended preventive therapy after CCTA vs. risk scoring (51% vs. 75%; p<0.001), adherence was greater (77% vs. 46%; p<0.001). As a result, lipid-lowering therapy (44% vs. 35%; p=0.08) and antiplatelet therapy (40% vs. 0.5%; p<0.001) use was higher in the CCTA vs. risk scoring group.

McDermott and colleagues write that overall, individuals in the CCTA group "had small incremental improvements in risk factors and 10-year cardiovascular risk, largely driven by those with CT-defined coronary atheroma."

In an accompanying editorial comment, Pamela S. Douglas, MD, MACC, and Neha J. Pagidipati, MD, FACC, write: "A preventive strategy incorporating CCTA appeared to be not only more precise but also more motivating to participants and clinicians. CCTA reclassified 1 in 3 individuals based on 10-year risk score, targeting therapy to those who were assumed to derive greatest benefit (although this has yet to be proven and will be evaluated in the ongoing trial)."