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

Xiaomeng Hou, Shulin Qiu, Xiaochen Chen Department of Health Care, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of ChinaCorrespondence: Xiaomeng Hou, Peking Union Medical College Hospital (Dongdan Campus), Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, People’s Republic of China, Tel +8613651268681, Email houxmeng@outlook.comPurpose: 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.Keywords: medication adherence, atherosclerosis secondary prevention, visual health education, cardiovascular risk factors, health literacy