UCLA researchers have found that undergoing a computer tomographic angiography was a better motivator to get people with suspected coronary artery disease to adopt healthier lifestyle practices than an exercise electrocardiography and stress test. A higher percentage of people who underwent the CTA test adopted healthier practices, including taking preventive medication, eating better and losing weight, while those who underwent the other tests did so at a lower rate.

Little is known about how CTA or an exercise electrocardiography and stress test might prompt someone who gets checked for coronary artery disease to adopt a healthier lifestyle.

To examine the factors influencing why people choose to adopt preventive medical therapy and healthier lifestyle practices, the researchers randomly assigned 10,003 people, who were symptomatic for coronary artery disease, to undergo a CTA or exercise electrocardiography and stress tests. They also assessed the association of preventive changes with major cardiovascular events. The study participants had a mean age of 61 and 53 percent of them were women. There were no differences among the study participants in medications or lifestyle at the start of the study.

The research team led by Dr. Joseph Ladapo, assistant professor of medicine at the David Geffen School of Medicine at UCLA, found that after 60 days a higher proportion of those who had the CTA had adopted preventive measures such as taking aspirin (11.8 percent versus 7.8 percent), statins (12.7 percent versus 6.2 percent), and beta-blockers (8.1 percent versus 5.3 percent), compared to those who underwent exercise electrocardiography and stress testing. They also found that more people in the CTA group were eating healthy, and rates of obesity or overweight status were lower, compared with other the group.

The researchers, however, observed no significant differences between CTA and stress testing strategies when it came to exercising, quitting smoking or losing weight. Also, positive initial test results and types of surgery like bypass or angioplasty, demonstrated stronger associations with preventive medications and lifestyle than the type of test the participants underwent.

Four million adults in the United States undergo stress testing or CTA each year because of suspected coronary disease. These patients are at high risk for heart problems, but they are often not treated with the right medications after testing. The study indicates that different tests lead to different rates of adoption of preventive care and lifestyle choices. It is likely that national testing practices need to be revised to reduce variation and uniformly improve cardiovascular disease prevention.

Ladapo is the lead author of the study. Other authors are Udo Hoffmann of Massachusetts General Hospital and Harvard Medical School; Kerry Lee, Adrian Coles, Megan Huang, Daniel Mark, Rowena Dolor, and Pamela Douglas of the Duke University School of Medicine; Robert Pelberg of Lindner Clinical Trial Center; Matthew Budoff of Los Angeles Biomedical Research Institute; Gardar Sigurdsson of University of Iowa Hospitals and Clinics; and Harry Severance of Erlanger Institute for Clinical Research.

The study was published in the Journal of the American Heart Association.

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The research was funded by National Heart, Lung, and Blood Institute grants R01 HL098237, R01 HL098236, R01, HL098305, R01 HL098235 and K23 HL116787.

DISCLOSURE: Ladapo serves as a consultant to CardioDx, Inc. Douglas reported receiving grant support from HeartFlow and serves on a data and safety monitoring board for General Electric Healthcare; Hoffmann reported receiving grant support from Siemens Healthcare and HeartFlow; Mark reported receiving personal fees from Medtronic, CardioDx, and St. Jude Medical and grant support from Eli Lilly, Bristol-Myers Squibb, Gilead Sciences, AGA Medical, Merck, Oxygen Biotherapeutics, and AstraZeneca; and Budoff reported receiving consulting fees from General Electric Healthcare. No other potential conflict of interest relevant to this article was reported.

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Enrique Rivero
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