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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article presented the results of the Cardiovascular Risk factors managEment in Asymptomatic hypertensIVE Subjects [CREATIVES] study. CREATIVES was a prospective, observational study conducted between January 2010 and May 2011.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EImaging Modalities\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EEndocrinology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes \u0026amp; Metabolic Syndrome\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EImaging Modalities\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EHyuk-Iae Chang, MD, PhD, Severance Cardiovascular Hospital, Seoul, South Korea, presented the results of the \u003Cstrong\u003EC\u003C\/strong\u003Eardiovascular \u003Cstrong\u003ER\u003C\/strong\u003Eisk factors manag\u003Cstrong\u003EE\u003C\/strong\u003Ement in \u003Cstrong\u003EA\u003C\/strong\u003Esymptoma\u003Cstrong\u003Et\u003C\/strong\u003Eic hypertens\u003Cstrong\u003EIVE\u003C\/strong\u003E \n         \u003Cstrong\u003ES\u003C\/strong\u003Eubjects (CREATIVES) study. CREATIVES was a prospective, observational study conducted between January 2010 and May 2011.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ENational Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) risk stratification that is based largely on the low-density lipoprotein cholesterol (LDL-C) level can overlook many patients with acute myocardial infarction (AMI) who would benefit from lifestyle modifications or statin therapy [Yoon YE et al. \u003Cem\u003EPrev Cardiol\u003C\/em\u003E 2009].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003ENoninvasive imaging may improve risk prediction and primary prevention of coronary artery disease (CAD). However, existing guidelines on the imaging of asymptomatic CAD patients differ regarding the need for additional imaging studies in patients without established CAD [Ferket BS et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EEvidence supporting the use of noninvasive imaging includes a 3-year follow-up study, in which computed tomography (CT) imaging of coronary calcium increased compliance with statin use [Kalia NK, Budoff M. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2012]. The EISNER trial also showed the ability and cost-effectiveness of imaging in spurring improvements in management of risk factors [Rozanski A et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2011]. However, other studies have had different results [McEvoy JW et al. \u003Cem\u003EArch Intern Med\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EDefining whether imaging studies have a role in guiding lipid therapy is important in light of the proven benefits of statins in the prevention of and treatment following AMI [Penning-van Beest FJ et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2007; Chapman RH et al. \u003Cem\u003EPatient Prefer Adherence\u003C\/em\u003E 2009]. The CREATIVES study assessed whether use of ultrasound scanning of carotid intima media thickness (CIMT) or plaque to classify asymptomatic hypertensive patients for their cardiovascular disease (CVD) risk encouraged beneficial behavioral changes.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EPatients (n=347) were enrolled from 22 hospitals in South Korea. Patients included in the study had hypertension (defined as systolic blood pressure [SBP] \u2265140 mm Hg or use of antihypertensive medication) and were aged 45 to 75 years (men) and 55 to 75 years (women). Patients with previously documented CAD, cerebrovascular, or peripheral arterial disease, and those with symptomatic heart failure were excluded.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EPatients were considered to be high risk for CVD if they had a carotid plaque or CIMT \u0026gt;0.9 mm on ultrasound. Patients were surveyed with a questionnaire and scored based upon the health-related behaviors such as smoking, exercise, consumption of salty foods and vegetables, and medication compliance. The high- and non-high risk groups comprised 182 and 165 patients, respectively. Significant differences at baseline were present in average age (62\u00b17 and 60\u00b18 years, respectively; p\u0026lt;0.001), duration of hypertension (5.3\u00b16.0 and 4.0\u00b14.3 years; p=0.024), triglyceride level (138\u00b171 and 156\u00b196 mg\/dL; p=0.040), use of antiplatelet agents (72% and 47%; p=0.030), and higher Framingham scores for high-risk patients (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E; p=0.005).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/13614\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/13614\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13614\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-9\u0022 class=\u0022first-child\u0022\u003EFramingham Risk Scores\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-11\u0022\u003EAfter carotid ultrasound examination, SBP and LDL-C were lowered in 26% and 52% of the high-risk patients, respectively, versus 6% and 24% of the non-high-risk patients, respectively. The findings persisted in patients classified as low- and moderate-risk by NCEP-ATP III criteria. Smoking, salty food intake, and medication compliance were improved in all patients after 6 months.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EMultivariate analysis of the improvements in SBP and LDL-C revealed that classification as high-risk by carotid ultrasound was the sole independent factor associated with improved cholesterol level.\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EThese findings that carotid ultrasound screening is associated with improved management of hyperlipidemia add support for the value of noninvasive imaging to screen for CVD risk in asymptomatic hypertensive patients. The benefits included improved physician behavior to reach target levels for SBP and LDL-C and improved health behaviors in both patient groups.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/13\/16\/13.2.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznm5e\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nznm5e\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}