Presentation of ultrasonographic pictorial information to individuals about their subclinical carotid atherosclerosis can help to improve their understanding and motivation to adhere to clinical recommendations and reduce their cardiovascular risk. This finding comes from the VIPVIZA trial, part of the Västerbotten Intervention Programme aimed at population-based prevention of cardiovascular disease in northern Sweden.

In the pragmatic, open-label VIPVIZA trial, 3,532 individuals aged 40, 50 or 60 years with one or more traditional cardiovascular risk factors were recruited and underwent clinical examination, blood sampling and ultrasonographic assessment of carotid intima–media thickness and plaque formation. Individuals were then randomly assigned to an intervention group (pictorial representation of the carotid ultrasonograph plus a telephone call from a nurse to confirm understanding, in addition to standard care) or a control group (standard care with no additional information).

After 1 year of follow-up, the Framingham Risk Score had decreased from baseline in the intervention group (–0.58, 95% CI –0.86 to –0.30) and had increased from baseline in the control group (+0.35, 95% CI 0.08–0.63). By contrast, the European Systematic Coronary Risk Evaluation had increased in the intervention group (+0.13, 95% CI 0.09–0.18) and to a greater extent in the control group (+0.27, 95% CI 0.23–0.30).

“This study provides evidence of the contributory role of pictorial presentation of silent atherosclerosis for prevention of cardiovascular disease,” conclude the investigators, writing in The Lancet. “It is a low-intensity intervention that is valid for clinical practice. This simple intervention could easily be applied in general practice in other similar settings.”