Cardiovascular Diseases
Conditions
Keywords
Cardiology, Computed tomography coronary angiography
Brief summary
It is hypothesised that, in individuals being considered for cardiovascular preventative therapy, computed tomography coronary angiography guided management will reduce the future risk of coronary heart disease death or non-fatal myocardial infarction compared to management guided by the current standard of care, a cardiovascular risk score.
Detailed description
Prevention of cardiovascular disease is currently guided by probabilistic risk scores that both over and under treat individuals, commit most middle-aged people to pharmacotherapy, and have little evidence base. It has been demonstrated that use of computed tomography coronary angiography (CTCA) is associated with changes in the diagnosis and treatment of patients presenting with stable chest pain, and that this leads to a marked reduction in the future risk of myocardial infarction. Importantly, the proportionate reduction in coronary events was most marked in those with non-anginal chest pain irrespective of their cardiovascular risk score which again demonstrated poor discrimination. The research team propose a randomised controlled trial of at least 6,000 middle-aged individuals at risk of cardiovascular disease that will compare these two strategies of targeting preventative therapies: a probabilistic cardiovascular risk score, and screening with CTCA. This trial will determine if CTCA guided management will be associated with better targeted intervention, prevent over medicating the general population, and result in fewer future coronary heart disease events than the current standard of care using a cardiovascular risk score.
Interventions
DIAGNOSTIC_TESTComputed tomography coronary angiography
CTCA \>64 detector row scanner
OTHERASSIGN Score
ASSIGN Cardiovascular Risk Score
Sponsors
British Heart Foundation
NHS Lothian
University of Edinburgh
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
40 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* ≥40 and ≤70 years of age * Resident in Scotland and have a Community Health Index (CHI) number * One or more of the following risk factors: * \>60 years of age * Current or recent (within 12 months) smoker * Clinical diagnosis of hypertension * Known hypercholesterolaemia or total cholesterol \>6.0 mmol/L or receiving statin therapy * Diabetes mellitus * Rheumatoid arthritis * Systemic lupus erythematosus (SLE) * Family history of premature cardiovascular disease (first degree relative with atherosclerotic cardiovascular disease below 60 years) * Chronic kidney disease stage 3 (estimate glomerular filtration rate 30-59 mL/min/1.73 m2).
Exclusion criteria
* Inability to undergo CTCA * Known coronary heart disease or other major atherosclerotic cardiovascular disease * Prior invasive or non-invasive coronary angiography within the last 5 years * Chronic kidney disease stage ≥4 (estimate glomerular filtration rate \<30 mL/min/1.73 m2) * Known homozygous familial hypercholesterolaemia or other serious inherited disorders of lipid metabolism requiring statin therapy * Intolerance of all statins * Statin therapy for \>2 years. * Previous coronary artery imaging completed specifically for cardiovascular risk assessment with a result of \>10 AU.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Coronary heart disease death or non-fatal myocardial infarction | 5 years | The primary research objective of the trial is to determine whether, in individuals with risk for cardiovascular disease, coronary heart disease screening with CTCA is associated with a reduction in the rate of coronary heart disease death or non-fatal myocardial infarction when compared to a probabilistic cardiovascular risk score approach. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Cardiovascular Events | 5 Years | Number of participants who have fatal and non-fatal myocardial infarction or stroke |
| Cardiovascular Procedures | 5 Years | Number of Invasive coronary angiography and coronary revascularisation procedures |
| Quality of Life (EQ-5D-5L) | 2 Years | Quality of life measured using EQ-5D-5L instrument |
| Prescription | 5 Years | Rates of prescription of preventative therapies (anti-platelet, statin and angiotensin-converting enzyme inhibitor therapies) |
| Death | 5 Years | Number of all-cause, cardiovascular, coronary heart disease and non-cardiovascular deaths |
| Health Economics | 2 Years | Health economic assessment of cost-effectiveness |
| Cholesterol | 5 Years | Serum cholesterol concentration |
| Disadvantages of CTCA- Radiation | 5 Years | Radiation dose (mGy-cm) |
| Disadvantages of CTCA- incidental findings | 5 Years | Number of participants with incidental findings from CTCA |
| Lifestyle Modification | 2 Years | Uptake of lifestyle modifications (smoking, exercise and diet) measured using self-reported questionnaire |
Countries
United Kingdom
Outcome results
None listed