Picture of Incidental Calcium To Understand Risk Estimate (PICTURE) Trial

NOTIFY 2: Picture of Incidental Calcium To Understand Risk Estimate

This is a prospective randomized controlled trial assessing the impact of notifying patients and their clinicians of an incidental finding of coronary artery calcification (CAC) indicating increased cardiovascular risk. Patients will be identified through completed radiology orders for non-gated, non-contrast chest CT in the appropriate clinical context and then will have an EHR screen for inclusion criteria. The presence of CAC will be confirmed by a radiologist. Eligible patients will be randomized to CAC notification or usual care using a 1:1 stratified block randomization method based on baseline ASCVD.

Inclusion Criteria:

• Age 18 and above and <85

• Non-gated chest CT with CAC

• An encounter after July 1, 2021 with a Stanford-affiliated clinician from one of the following clinics:

  • Stanford Internal Medicine (includes University affiliated clinics)
  • Stanford Family Medicine (includes University affiliated clinics)
  • Non-EP cardiologist

Exclusion Criteria:

• Advanced or poor-prognostic cancer
• No active primary care or cardiology care at Stanford Health Care
• Primary language other than English, Spanish, Vietnamese, Cantonese, or Mandarin
• Baseline statin or non-statin lipid lowering therapy
• Allergy to statin medication or identification of statin-associated muscle symptom