Utilizing existing test results to improve primary prevention in patients with subclinical coronary atherosclerosis: the USE-IT study

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Abstract Introduction Subclinical coronary atherosclerotic disease is associated with an increased risk of cardiovascular events during follow-up, especially when extensive. Clinical guidelines are increasingly emphasizing the importance of optimized treatment for these patients. Despite this, a clinic focused on the detection and management of patients with subclinical coronary disease (typically detected incidentally) is a highly innovative strategy in our country. We created a dedicated strategy and clinic, aimed at enhancing the identification, referral, and management of patients with subclinical atherosclerotic disease, prioritizing the use of existing test results to identify patients with prevalent subclinical disease. Purpose The aim of USE-IT Study was to evaluate the impact of this intervention on LDL cholesterol levels and control of other risk factors during follow-up in this patient population. Methods Single-center, prospective, non-randomized, real-world study. Cardiovascular risk reduction interventions based on ESC guidelines were performed. Our primary endpoint was change in LDL cholesterol levels at the end of follow-up. Results Enrollment took place between Oct 2022 and Jan 2025. A total of 235 patients were included (mean age 65±9 years, 42% women). Referral followed the detection of subclinical coronary disease by coronary CT (33%), chest CT (41%), invasive angiography (24%), or other methods (2%). Of the patients with data on affected vessels, 67.3% had ≥2 vessels involved, and of those with available CAC score data, 73.4% had a score ≥100. Median follow-up was 311 days. We observed large and statistically significant reductions in LDL cholesterol levels at the end of follow-up, as well as substantial decreases in the prevalence of active and passive smoking, and a modest reduction in the cohort's average weight (Figure 1) The use of any statin, high-intensity statins, and ezetimibe increased significantly during follow-up, with high-intensity statin use doubling and ezetimibe use rising sevenfold (Fig 2) A sensitivity analysis restricted to 76 patients in whom subclinical atherosclerosis had been detected ≥1 year prior to referral to our clinic demonstrated significant improvements in LDL-C levels when comparing pre-referral management to the end of follow-up (Fig 1). Positive trends were also observed for other risk factors, with a significant increase in the use of statins, high-intensity statins, and ezetimibe (Fig 2) Conclusion(s) The USE-IT intervention led to significant reductions in LDL cholesterol levels, alongside an improvement in smoking prevalence and other cardiovascular risk factors. An enhanced use of guideline-recommended lipid-lowering therapies, majorly statins and ezetimibe, was observed. These results were consistent in sensitivity analyses, reinforcing the effectiveness of this strategy in patients with incidentally detected subclinical coronary atherosclerosis.

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