Showing people their own arteries might improve heart health

(Reuters Health) - - People who see vivid pictures of their own arteries getting clogged up with debris may be more likely to adopt a heart-healthy lifestyle than individuals who don’t see these images, a recent experiment suggests.

One of the biggest stumbling blocks to preventing cardiovascular disease can be patients’ inability to follow recommendations to do things like stop smoking, drink in moderation, exercise more regularly and eat well. For the current study, researchers randomly assigned 3,532 people with at least one risk factor for heart disease but no symptoms to get only usual care, such as lifestyle advice or medications, or to also receive pictures of their arteries and personalized tutorials on why the images might signal health problems ahead.

One year later, people who saw the images of their own blood vessels had fewer risk factors for heart disease than the control group of patients who didn’t see images of their own bodies, researchers report in The Lancet.

“Smoking cessation, anti-hypertensive and cholesterol-lowering medication, healthy diet and physical activity are the most effective, evidence-based and cheapest therapies in medicine - as long as individuals adhere to it long-term,” said lead study author Ulf Naslund of Umea University in Sweden.

“The major problem is not lack of therapies, but it is rather non-adherence to these medications and lifestyle changes,” Naslund said by email. “The results in the study demonstrate one way to deal with the big problem in prevention - non-adherence.”

Study participants ranged in age from 40 to 60. They all completed surveys about risk factors for heart disease, had blood tests to assess risk factors like high cholesterol or high blood sugar, and had ultrasounds of their arteries to look for thickening or hardening of artery walls and plaque accumulation.

All participants also received information about their cardiovascular risk factors and advice on how to adopt a healthier lifestyle and take any needed medications.

One year later, people who had seen the pictures of their own arteries had lower average risk scores for heart disease than they did before they saw the images, based on one common assessment tool known as the Framingham risk score. But in the control group, patients’ average Framingham risk score increased.

By another measure known as the European systematic coronary risk evaluation, people who saw pictures of their arteries improved twice as much as patients in the control group, even though the gains overall were modest.

Both groups also achieved lower total cholesterol by the end of the year-long study, with greater improvements in the image group than the control group.

Beyond its relatively short duration, the study also wasn’t designed to determine why showing patients pictures of their arteries changes their behaviors, and if it directly influences their risk of events like heart attacks or strokes.

Still, the images may help get a message across that just talking to patients cannot convey, said the coauthor of an accompanying editorial, Richard Kones of the Cardiometabolic Research Institute in Houston, Texas.

“Many people believe they are heart-healthy when they are not,” Kones said by email.

Heart disease prevention can be particularly challenging for people who are relatively young and don’t feel any symptoms of heart disease, Kones said by email. Atherosclerosis, or hardening of the arteries, can be a silent killer because it takes decades to develop and may not be felt by patients until it’s quite advanced and difficult to treat.

“Since atherosclerosis is silent, even after physicians tell their patients about the need to adhere to treatments, studies have shown that patients remember only a small fraction of what they are told,” Kones added. “Visual graphics and pictures are more effective, as this trial found; the expression “a picture is worth a thousand words” is hard-wired into us.”

SOURCE: and The Lancet, online December 3, 2018.