Coronary computed tomography angiography to guide lipid management in an asymptomatic community-based population: RESPECT2 randomized controlled trial
In brief
CT coronary scan raises regular lipid-lowering drug use to 12.5% versus 8%
In a community trial of adults 40-69 without prior heart disease, CT coronary angiography identified atherosclerosis in 37% and led to regular lipid-lowering medication use in 12.5% of participants, compared with 8% using risk-score guidance alone. The approach modestly improved treatment adherence but also prompted many more invasive coronary procedures, and its impact on hard cardiovascular events remains unknown.
- Journal
- European journal of preventive cardiology (Q1)
- Published
- 28 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Xiang Guo, Ying Zhu, Yanming Li, Shuaishuai Qiu, Jialuo Yang, Chao Li, et al.
- PMID
- 42661433
- DOI
- 10.1093/eurjpc/zwag418
Why clinicians should know about it
- Picked for Cardiology and Cardiovascular Medicine (top studies of the week, 30 August 2026): CCTA‑guided strategy modestly improves lipid‑lowering medication use
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Abstract
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.