European journal of preventive cardiology · 2026
Coronary computed tomography angiography to guide lipid management in an asymptomatic community-based population: RESPECT2 randomized controlled trial.
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Guo Xiang, Zhu Ying, Li Yanming, Qiu Shuaishuai, Yang Jialuo, Li Chao, Zhu Yuhao, Zhong Jian, Zhang Jun, Zhou Changsheng, Bao Xueqin, Yi Dongna, Cai Jun, Chen Yingqi, Li Jianhua, Wei Yongyue, Liu Yuxiu, Cheng Xiaoqing, Tang Chunxiang, Zhang Long Jiang
Аннотация
AIMS: Cardiovascular disease (CVD) risk assessment and risk-guided lipid management are cornerstones of primary prevention of atherosclerotic coronary artery disease (ACAD). However, the 10-year CVD risk is often limited by individual-level inaccuracy and poor adherence. This trial aimed to determine whether a coronary computed tomography angiography (CCTA)-guided strategy improves lipid management in asymptomatic populations.
METHODS AND RESULTS: This pragmatic, open-label, assessor-blinded randomized trial was conducted in Nanjing, China. Asymptomatic community-dwelling adults aged 40-69 years with no history of CVD or prior use of lipid-lowering medication (LLM) were recruited. Participants were randomized to receive individualized LLM recommendations based either on CCTA findings (CCTA group) or on 10-year CVD risk (usual-care group). The primary outcome was the proportion of participants with regular LLM use (≥24 of preceding 30 days) at both the 6-month and 12-month follow-up visits. Of 3503 randomized participants, 3491 (1748 CCTA, 1743 usual-care) were included in the primary analysis (median [IQR] age, 55 [48-61] years; 60.2% women). Among 1516 participants undergoing CCTA, ACAD was detected in 565 (37.3%). The median follow-up was 12.5 months. Regular LLM use was higher in the CCTA group than in the usual-care group (12.5% [218/1748] vs. 8.1% [141/1743]; adjusted risk ratio, 1.57 [95% confidence interval, 1.29-1.91]; P < 0.001). During follow-up, invasive coronary procedures were more frequent in the CCTA group than in the usual-care group (29 procedures vs. 1).
CONCLUSION: In asymptomatic populations, a CCTA-guided strategy modestly improved lipid management, though it increased invasive coronary procedures. Longer follow-up is needed to determine its effect on clinical events. Study Registration http://www.clinicaltrials.com; Identifier: NCT05725096.
METHODS AND RESULTS: This pragmatic, open-label, assessor-blinded randomized trial was conducted in Nanjing, China. Asymptomatic community-dwelling adults aged 40-69 years with no history of CVD or prior use of lipid-lowering medication (LLM) were recruited. Participants were randomized to receive individualized LLM recommendations based either on CCTA findings (CCTA group) or on 10-year CVD risk (usual-care group). The primary outcome was the proportion of participants with regular LLM use (≥24 of preceding 30 days) at both the 6-month and 12-month follow-up visits. Of 3503 randomized participants, 3491 (1748 CCTA, 1743 usual-care) were included in the primary analysis (median [IQR] age, 55 [48-61] years; 60.2% women). Among 1516 participants undergoing CCTA, ACAD was detected in 565 (37.3%). The median follow-up was 12.5 months. Regular LLM use was higher in the CCTA group than in the usual-care group (12.5% [218/1748] vs. 8.1% [141/1743]; adjusted risk ratio, 1.57 [95% confidence interval, 1.29-1.91]; P < 0.001). During follow-up, invasive coronary procedures were more frequent in the CCTA group than in the usual-care group (29 procedures vs. 1).
CONCLUSION: In asymptomatic populations, a CCTA-guided strategy modestly improved lipid management, though it increased invasive coronary procedures. Longer follow-up is needed to determine its effect on clinical events. Study Registration http://www.clinicaltrials.com; Identifier: NCT05725096.