title: Visualizing coronary calcium is associated with improvements in adherence to statin therapy.
abstract: BACKGROUND
  Many patients lack motivation to control cardiovascular risk factors and clinicians have long sought ways to activate apathetic patients. Despite significant and consistent data on the benefits of lipid-lowering agents to reduce cardiovascular events, adherence and utilization of these agents remains low. We evaluated whether visualization of coronary calcium would positively affect patients' adherence rates.
  
  
  METHODS
  We evaluated patients who underwent electron beam tomography (EBT) coronary calcium evaluation at least 1 year prior with a survey questioning them about health behaviors. Patients filled out baseline and follow-up questionnaires relating to lifestyle modifications, including statin utilization, diet, exercise, tobacco cessation and vitamin/antioxidant utilization.
  
  
  RESULTS
  The study population consisted of 505 individuals on statin therapy on baseline who were followed for a mean of 3 +/- 2 years. Overall the statin compliance was lowest (44%) among those with CAC score in the first quartile (0-30), whereas 91% of individuals with baseline CAC score in the fourth quartile (>or= 526) adhered to statin therapy. In multivariable analysis, after adjusting for cardiovascular risk factors, age, and gender, higher baseline CAC scores were strongly associated with adherence to statin therapy.
  
  
  CONCLUSIONS
  In addition to risk stratification for the asymptomatic person, patients visualizing coronary artery calcium may improve utilization and adherence to lipid-lowering therapy. Outcome studies and randomized trials need to be done to quantify the true value and cost-effectiveness of this approach.
authors.affiliation: Division of Cardiology, Harbor-UCLA Medical Center, Research and Education Institute, Torrance, CA, USA.
authors.forename: Nove K
authors.initials: NK
authors.lastname: Kalia
authors.forename: Loren G
authors.initials: LG
authors.lastname: Miller
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.forename: Nisha
authors.initials: N
authors.lastname: Agrawal
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
mesh_terms: D002114:Calcinosis / Q000000981:diagnostic imaging*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000523:psychology; D003331:Coronary Vessels; D005260:Female; D015438:Health Behavior; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors