CT-Based Visual Atherosclerosis Education Improves Secondary Prevention Adherence: A Retrospective Cohort Study Using Cluster Analysis

Purpose: Suboptimal adherence to pharmacotherapy for modifiable atherosclerotic risk factors (hypertension, dyslipidaemia, and diabetes) remains a major barrier to effective secondary prevention, particularly in newly diagnosed middle-aged individuals. Patients and Methods: This retrospective cohort study evaluated the effects of a novel visually aided atherosclerosis education intervention in which clinicians used computed tomography (CT) images to show atherosclerotic calcification and explain plaque progression on adherence. Non-smoking males aged 45-60 years (n = 153) who underwent health screening at Peking Union Medical College Hospital (March-October, 2024) were stratified into educated (CT-based visualisation of atherosclerotic calcification progression and risk factor education, n = 76) and non-educated (n = 77) groups. K-means cluster analysis was used to classify participants based on low-density lipoprotein cholesterol (LDL-C), glycated haemoglobin (HbA1c), and systolic blood pressure (SBP) control as a proxy for adherence. Group differences in cluster distribution (reflecting adherence patterns) were assessed using the chi-square test. Results: Cluster analysis identified four distinct adherence patterns: cluster 1 (Optimal Control, 67 patients), cluster 2 (Suboptimal Lipid Control, 61 patients), cluster 3 (Suboptimal Glycaemic Control, 14 patients), and cluster 4 (Suboptimal BP Control, 11 patients). The educated group had significantly more individuals in Cluster 1 (Optimal Control: 53.9% vs 33.8% in the uneducated group, p = 0.012) and fewer suboptimally controlled risk factors (46.1% vs 66.2%, p = 0.012). Conclusion: Structured, visually aided atherosclerosis education significantly improved adherence to secondary prevention measures and optimised risk factor control. Integrating this evidence-based intervention into routine clinical practice may enhance patient engagement and improve long-term outcomes.