Imaging of subclinical atherosclerosis - Impact on self-rated CVD risk and beliefs about possibilities to influence personal risk
Authors: Andersson E , Nordin S , Lindvall K , Liv P , Naslund U 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): The Heart Foundation in Northern Sweden, Swedish Research Council.

Background
Adequate risk perception of cardiovascular disease (CVD) and beliefs about the possibility to influence personal risk (efficacy beliefs) are important factors for adherence to preventive guidelines. Risk communication about subclinical atherosclerosis can improve CVD risk, but whether this information leads to long-term shifts in risk perception and efficacy beliefs is not known.

Purpose
To study whether personalized, colour-coded and age-related risk communication about atherosclerosis and motivational conversation impact on self-rated CVD risk and efficacy beliefs, and whether this is moderated by sex and education. Also, if an intervention effect on self-rated risk is moderated by CVD risk.

Method
Visualization of Asymptomatic Atherosclerotic Disease for Optimum Cardiovascular Prevention (VIPVIZA), is a pragmatic, open-label, randomized controlled trial with masked evaluators that investigates the impact of pictorial information about subclinical atherosclerosis, added to traditional risk factor-based communication. Participants’ (n= 3532) self-rated CVD risk and efficacy beliefs were assessed with a Likert scale (0-10) at baseline, 1-year and 3-year follow-up in the intervention and control group. The intervention was the main exposure with two comparative approaches: (1) two levels: intervention vs controls, (2) in the intervention group only, four levels of risk as presented in the infographic: IMT coded as green+yellow or orange+red, with or without occurrence of plaque. A mixed model analysis was applied with follow-up measurement (1 year and 3 years) as dependent variables with group, time point and group x time interaction as fixed effects. The model was adjusted for baseline value and time x baseline value interaction. ANCOVAs assessed whether the intervention effect on self-rated risk was moderated by CVD risk.

Results
After one year, the intervention group rated their CVD risk as higher (m=0.455, 95% CI 0.323-0.587; p &lt;.001), with a sustained effect also after 3 years (m=0.566, 95% CI 0.431-0.701; p &lt;.001). The effect of the intervention on self-rated CVD risk was constant in stratified analyses by sex and level of education. Even though risk perception did increase, overall, the intervention did not have an effect on beliefs about the possibility to influence personal risk, except in participants with high education, where efficacy beliefs decreased. The intervention effect on self-rated risk was moderated by CVD risk only in women after 3 years. In the intervention group, differences in self-rated CVD risk were found between participants with different colour-coded risk messages on atherosclerosis status, where self-rated CVD risk increased with message severity.

Conclusion
Personalized, colour-coded and age-related risk communication about asymptomatic atherosclerosis had an effect on self-rated risk for CVD with a sustained effect after 3 years. Beliefs about possibilities to influence the risk were unchanged.