SCOT-HEART 2 Trial: CT Angiography Boosts Lifestyle Changes and Preventive Therapy in Cardiovascular Care
UK: A new study published in JAMA Cardiology highlights the potential of coronary computed tomography (CT) angiography to promote healthier lifestyle choices and improved adherence to preventive therapies in individuals at risk for cardiovascular disease. The substudy, conducted within the larger SCOT-HEART 2 randomized clinical trial, was led by Dr. Michael McDermott of the British Heart Foundation Centre of Research Excellence, University of Edinburgh, and colleagues.
Despite increasing awareness of heart disease prevention, the adoption of healthy lifestyle habits and primary preventive treatments often remains suboptimal. The research team aimed to assess whether CT angiography could motivate individuals to embrace lifestyle modifications and adhere to recommended therapies more effectively than traditional cardiovascular risk scoring.
The substudy enrolled 400 asymptomatic adults aged 40 to 70 years with at least one cardiovascular risk factor, but no known cardiovascular disease. Participants were randomly assigned to receive either guideline-based cardiovascular risk scoring or coronary CT angiography, followed by personalized lifestyle advice. Those identified with coronary atherosclerosis on imaging were also advised to start antiplatelet and statin therapy. The primary focus was on changes in diet, physical activity, body weight, and smoking status after six months.
The key findings were as follows:
- 17% of participants who underwent CT angiography adopted healthier lifestyle behaviors, compared to 6% in the risk-scoring group.
- Fewer participants in the CT angiography group were recommended preventive therapies (51%) compared to the risk-scoring group (75%).
- Willingness to follow preventive treatment recommendations was higher in the CT angiography group (77%) than in the risk-scoring group (46%).
- The overall use of lipid-lowering therapies was similar between both groups.
- Antiplatelet therapy use was much higher in the CT angiography group (40%) compared to the risk-scoring group (0.5%).
- Participants in the CT angiography group showed modest improvements in blood pressure, cholesterol levels, and 10-year cardiovascular risk estimates, especially in those with coronary atheroma.
“These findings suggest that seeing clear evidence of coronary atherosclerosis through imaging may motivate patients to take preventive action more seriously,” the authors noted. However, they also emphasized that it remains unclear whether such a strategy ultimately translates to fewer coronary events over the long term.
The authors concluded, "Overall, this substudy emphasizes the potential value of incorporating coronary CT angiography into preventive care strategies, not only to guide therapy but also to foster greater engagement in heart-healthy behaviors. Future research will be needed to confirm whether these improvements in risk factor management can lead to better clinical outcomes."
Reference:
McDermott M, Khaing PH, Meah MN, et al. CT Angiography, Healthy Lifestyle Behaviors, and Preventive Therapy: A Nested Substudy of the SCOT-HEART 2 Randomized Clinical Trial. JAMA Cardiol. Published online June 18, 2025. doi:10.1001/jamacardio.2025.1763
