{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:28:27Z","timestamp":1792787307111,"version":"4.5.0"},"reference-count":49,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"unspecified","delay-in-days":22,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Heart and Lung Foundation","award":["20150369"],"award-info":[{"award-number":["20150369"]}]},{"name":"Heart and Lung Foundation","award":["20170481"],"award-info":[{"award-number":["20170481"]}]},{"name":"Heart and Lung Foundation","award":["371130520"],"award-info":[{"award-number":["371130520"]}]},{"name":"STROKE - the national association"},{"name":"Swedish Society of Medicine","id":[{"id":"https:\/\/ror.org\/016ks4x90","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Heart Foundation in Northern Sweden"},{"name":"SKANDIA Risk & Health"},{"name":"Carl Bennet Ltd, Sweden"},{"name":"Region V\u00e4sterbotten","award":["7004571"],"award-info":[{"award-number":["7004571"]}]},{"name":"Region V\u00e4sterbotten","award":["ALFVLL-298001"],"award-info":[{"award-number":["ALFVLL-298001"]}]},{"name":"Region V\u00e4sterbotten","award":["ALFVLL-643391"],"award-info":[{"award-number":["ALFVLL-643391"]}]},{"name":"Region V\u00e4sternorrland, Research and Development","id":[{"id":"https:\/\/ror.org\/03arxaz40","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Swedish Research Council","award":["2016-01891"],"award-info":[{"award-number":["2016-01891"]}],"id":[{"id":"https:\/\/ror.org\/03zttf063","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Swedish Research Council","award":["521-2013-2708"],"award-info":[{"award-number":["521-2013-2708"]}],"id":[{"id":"https:\/\/ror.org\/03zttf063","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/100018870","name":"Riksf\u00f6rbundet Hj\u00e4rtLung","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100018870","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Swedish Insurance Society","id":[{"id":"https:\/\/ror.org\/00j3hvh68","id-type":"ROR","asserted-by":"crossref"}]},{"name":"The four Northern Regions"},{"name":"Ume\u00e5 University, Department of Public Health and Clinical Medicine"},{"name":"The Heart Foundation of Northern Sweden"},{"name":"V\u00e4sterbotten Heart and Lung Association"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2026,6,12]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>Low adherence to a healthy lifestyle constitutes a major barrier to effective prevention of cardiovascular disease. We aimed to investigate the effect of pictorial-based information about subclinical atherosclerosis on adherence to health-promoting lifestyle recommendations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Visualization of Asymptomatic Atherosclerotic Disease for Optimum Cardiovascular Prevention (VIPVIZA) is a pragmatic, open-label randomised controlled trial within the V\u00e4sterbotten Intervention Programme (VIP) in Sweden. In the VIP, residents of V\u00e4sterbotten county are invited to a health survey and a health-promoting dialogue at the ages of 40, 50 and 60.<\/jats:p>\n                    <jats:p>A total of 3532 VIP participants were included in VIPVIZA during 2013\u20132016. They underwent a carotid ultrasound examination in addition to the usual VIP process and were randomised 1:1 to intervention group (receiving graphical colour-coded and age-related information about carotid intima-media thickness and plaques, written information about atherosclerosis and a motivational dialogue) or control group (no information or dialogue).<\/jats:p>\n                    <jats:p>We developed a lifestyle index based on self-reported physical activity, smoking habits, diet and alcohol consumption, ranging from 4 to 12, with higher levels indicating healthier lifestyles. We used ordinal regression to compare the lifestyle index in the intervention and control groups at the 3-year follow-up, with adjustments for baseline levels of lifestyle index, age, sex and education.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The OR for having a healthier lifestyle index after 3 years was 1.20 (95% CI 1.01 to 1.42, p=0.03), comparing the intervention group to the control group. We found no interactions for age, sex or education.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our findings provide some evidence for the contributory role of pictorial-based information about subclinical atherosclerosis in promoting sustained healthy lifestyle habits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT01849575\">NCT01849575<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2026-004136","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T16:30:38Z","timestamp":1784824238000},"page":"e004136","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of pictorial-based information about atherosclerosis on adherence to lifestyle recommendations: results from the VIPVIZA randomised controlled trial"],"prefix":"10.1136","volume":"13","clinical-trial-number":[{"clinical-trial-number":"nct01849575","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct01849575","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-8114-9349","authenticated-orcid":false,"given":"Andree Christian","family":"Wennstig","sequence":"first","affiliation":[{"name":"Department of Public Health and Clinical Medicine, Ume\u00e5 University, Ume\u00e5, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1239-6239","authenticated-orcid":false,"given":"Sara","family":"Sj\u00e4lander","sequence":"additional","affiliation":[{"name":"Department of Public Health and Clinical Medicine, Ume\u00e5 University, Ume\u00e5, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4341-1745","authenticated-orcid":false,"given":"Andreas","family":"Hult","sequence":"additional","affiliation":[{"name":"Department of Community Medicine and Rehabilitation, Ume\u00e5 University, Ume\u00e5, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5494-8134","authenticated-orcid":false,"given":"Per","family":"Liv","sequence":"additional","affiliation":[{"name":"Department of Public Health and Clinical Medicine, Ume\u00e5 University, Ume\u00e5, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2475-7131","authenticated-orcid":false,"given":"Margareta","family":"Norberg","sequence":"additional","affiliation":[{"name":"Department of Public Health and Clinical Medicine, Ume\u00e5 University, Ume\u00e5, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1673-8494","authenticated-orcid":false,"given":"Maria","family":"Wennberg","sequence":"additional","affiliation":[{"name":"Department of Public Health and Clinical Medicine, Ume\u00e5 University, Ume\u00e5, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0394-5096","authenticated-orcid":false,"given":"Per","family":"Wester","sequence":"additional","affiliation":[{"name":"Department of Public Health and Clinical Medicine, Ume\u00e5 University, Ume\u00e5, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1617-6102","authenticated-orcid":false,"given":"Patrik","family":"Wennberg","sequence":"additional","affiliation":[{"name":"Department of Public Health and Clinical Medicine, Ume\u00e5 University, Ume\u00e5, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"2026091603502642000_13.2.e004136.1","doi-asserted-by":"publisher","DOI":"10.1093\/eurjpc\/zwab154"},{"key":"2026091603502642000_13.2.e004136.2","doi-asserted-by":"crossref","DOI":"10.1186\/s12966-024-01586-7","article-title":"Lifestyle behaviors and risk of cardiovascular disease and prognosis among individuals with cardiovascular disease: a systematic review and meta-analysis of 71 prospective cohort studies","volume":"21","author":"Wu","year":"2024","journal-title":"Int J Behav Nutr Phys Act"},{"key":"2026091603502642000_13.2.e004136.3","doi-asserted-by":"publisher","DOI":"10.1177\/2047487320908698"},{"key":"2026091603502642000_13.2.e004136.4","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2296-12-15","article-title":"How do family physicians communicate about cardiovascular risk? Frequencies and determinants of different communication formats","volume":"12","author":"Neuner-Jehle","year":"2011","journal-title":"BMC Fam Pract"},{"key":"2026091603502642000_13.2.e004136.5","doi-asserted-by":"crossref","first-page":"49","DOI":"10.2147\/RMHP.S8288","article-title":"Perceptions of risk: understanding cardiovascular disease","volume":"3","author":"Webster","year":"2010","journal-title":"Risk Manag Healthc Policy"},{"key":"2026091603502642000_13.2.e004136.6","doi-asserted-by":"crossref","DOI":"10.1186\/s12872-018-0990-2","article-title":"Effect of using cardiovascular risk scoring in routine risk assessment in primary prevention of cardiovascular disease: an overview of systematic reviews","volume":"19","author":"Studzi\u0144ski","year":"2019","journal-title":"BMC Cardiovasc Disord"},{"key":"2026091603502642000_13.2.e004136.7","first-page":"10","article-title":"Can Communicating Personalised Disease Risk Promote Healthy Behaviour Change","volume":"51","author":"French","year":"2017","journal-title":"A Systematic Review of Systematic Reviews Ann Behav Med"},{"key":"2026091603502642000_13.2.e004136.8","doi-asserted-by":"crossref","first-page":"3116","DOI":"10.1111\/jan.15327","article-title":"Cardiovascular risk communication strategies in primary prevention. A systematic review with narrative synthesis","volume":"78","author":"Schulberg","year":"2022","journal-title":"J Adv Nurs"},{"key":"2026091603502642000_13.2.e004136.9","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1080\/02813432.2021.1882083","article-title":"Increased knowledge makes a difference! - general practitioners\u2019 experiences of pictorial information about subclinical atherosclerosis for primary prevention: an interview study from the VIPVIZA trial","volume":"39","author":"Bengtsson","year":"2021","journal-title":"Scand J Prim Health Care"},{"key":"2026091603502642000_13.2.e004136.10","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.21683","article-title":"Prescription of Lipid-Lowering and Antihypertensive Drugs Following Pictorial Information About Subclinical Atherosclerosis: A Secondary Outcome of a Randomized Clinical Trial","volume":"4","author":"Sj\u00f6lander","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2026091603502642000_13.2.e004136.11","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1007\/s00228-024-03694-6","article-title":"Improved adherence to statin treatment and differences in results between men and women after pictorial risk communication-a sub-study of the VIPVIZA RCT","volume":"80","author":"Holmberg","year":"2024","journal-title":"Eur J Clin Pharmacol"},{"key":"2026091603502642000_13.2.e004136.12","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32818-6"},{"key":"2026091603502642000_13.2.e004136.13","doi-asserted-by":"crossref","DOI":"10.1016\/j.ajpc.2021.100199","article-title":"The beneficial effect over 3 years by pictorial information to patients and their physician about subclinical atherosclerosis and cardiovascular risk: Results from the VIPVIZA randomized clinical trial","volume":"7","author":"Bengtsson","year":"2021","journal-title":"Am J Prev Cardiol"},{"key":"2026091603502642000_13.2.e004136.14","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1111\/cpf.12811","article-title":"Reduced progression of carotid intima media thickness by personalised pictorial presentation of subclinical atherosclerosis in VIPVIZA-A randomised controlled trial","volume":"43","author":"Nyman","year":"2023","journal-title":"Clin Physiol Funct Imaging"},{"key":"2026091603502642000_13.2.e004136.15","doi-asserted-by":"crossref","first-page":"116530","DOI":"10.1016\/j.socscimed.2023.116530","article-title":"Does a multi-component intervention including pictorial risk communication about subclinical atherosclerosis improve perceptions of cardiovascular disease risk without deteriorating efficacy beliefs?","volume":"341","author":"Andersson","year":"2024","journal-title":"Soc Sci Med"},{"key":"2026091603502642000_13.2.e004136.16","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1093\/eurjpc\/zwac204","article-title":"How to optimize the adherence to a guideline-directed medical therapy in the secondary prevention of cardiovascular diseases: a clinical consensus statement from the European Association of Preventive Cardiology","volume":"30","author":"Pedretti","year":"2023","journal-title":"Eur J Prev Cardiol"},{"key":"2026091603502642000_13.2.e004136.17","doi-asserted-by":"crossref","DOI":"10.1186\/s12916-024-03588-5","article-title":"Strategies to improve the implementation of preventive care in primary care: a systematic review and meta-analysis","volume":"22","author":"Heath","year":"2024","journal-title":"BMC Med"},{"key":"2026091603502642000_13.2.e004136.18","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003920","article-title":"Visualising health risks with medical imaging for changing recipients\u2019 health behaviours and risk factors: Systematic review with meta-analysis","volume":"19","author":"Hollands","year":"2022","journal-title":"PLoS Med"},{"key":"2026091603502642000_13.2.e004136.19","doi-asserted-by":"crossref","unstructured":"Norberg M , Wall S , Boman K , et al . The V\u00e4sterbotten Intervention Programme: background, design and implications. Glob Health Action 2010;3. doi:10.3402\/gha.v3i0.4643","DOI":"10.3402\/gha.v3i0.4643"},{"key":"2026091603502642000_13.2.e004136.20","doi-asserted-by":"crossref","DOI":"10.1186\/s40359-023-01467-x","article-title":"From risk communication about asymptomatic atherosclerosis to cognitive and emotional reactions and lifestyle modification","volume":"12","author":"Andersson","year":"2024","journal-title":"BMC Psychol"},{"key":"2026091603502642000_13.2.e004136.21","doi-asserted-by":"publisher","DOI":"10.3402\/gha.v5i0.18394"},{"key":"2026091603502642000_13.2.e004136.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2018.04.046"},{"key":"2026091603502642000_13.2.e004136.23","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)17018-9"},{"key":"2026091603502642000_13.2.e004136.24","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)30506-2"},{"key":"2026091603502642000_13.2.e004136.25","unstructured":"Babor TF , Higgins B , John C , et al . AUDIT: The alcohol use disorders identification test: Guidelines for use in primary health care. 2nd edn. World Health Organisation, 2001."},{"key":"2026091603502642000_13.2.e004136.26","doi-asserted-by":"publisher","DOI":"10.1079\/PHN2001315"},{"key":"2026091603502642000_13.2.e004136.27","doi-asserted-by":"crossref","DOI":"10.1186\/s12937-017-0241-x","article-title":"Longitudinal 10-year changes in dietary intake and associations with cardio-metabolic risk factors in the Northern Sweden Health and Disease Study","volume":"16","author":"Winkvist","year":"2017","journal-title":"Nutr J"},{"key":"2026091603502642000_13.2.e004136.28","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0023384","article-title":"Food composition of the diet in relation to changes in waist circumference adjusted for body mass index","volume":"6","author":"Romaguera","year":"2011","journal-title":"PLoS One"},{"key":"2026091603502642000_13.2.e004136.29","unstructured":"Waist circumference and waist\u2013hip ratio: report of a who expert consultation. Geneva, 8\u201311 december 2008. World Health Organisation. World Health Organisation; 2008."},{"key":"2026091603502642000_13.2.e004136.30","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-018-5339-3","article-title":"A cost-effectiveness analysis of a community based CVD program in Sweden based on a retrospective register cohort","volume":"18","author":"Lindholm","year":"2018","journal-title":"BMC Public Health"},{"key":"2026091603502642000_13.2.e004136.31","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2015-009651","article-title":"Impact of a combined community and primary care prevention strategy on all-cause and cardiovascular mortality: a cohort analysis based on 1 million person-years of follow-up in V\u00e4sterbotten County, Sweden, during 1990-2006","volume":"5","author":"Blomstedt","year":"2015","journal-title":"BMJ Open"},{"key":"2026091603502642000_13.2.e004136.32","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0220889","article-title":"Robustness of statistical methods when measure is affected by ceiling and\/or floor effect","volume":"14","author":"\u0160imkovic","year":"2019","journal-title":"PLoS One"},{"key":"2026091603502642000_13.2.e004136.33","doi-asserted-by":"publisher","DOI":"10.1097\/HJR.0b013e32832b38a1"},{"key":"2026091603502642000_13.2.e004136.34","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2415879"},{"key":"2026091603502642000_13.2.e004136.35","doi-asserted-by":"publisher","DOI":"10.1007\/s12471-021-01642-y"},{"key":"2026091603502642000_13.2.e004136.36","doi-asserted-by":"crossref","first-page":"3732","DOI":"10.1093\/eurheartj\/ehac378","article-title":"Effects of a comprehensive lifestyle intervention on cardiovascular health: the TANSNIP-PESA trial","volume":"43","author":"Garcia-Lunar","year":"2022","journal-title":"Eur Heart J"},{"key":"2026091603502642000_13.2.e004136.37","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.atherosclerosis.2021.08.002","article-title":"Impact of a coronary artery calcium-guided statin treatment protocol on cardiovascular risk at 12 months: Results from a pragmatic, randomised controlled trial","volume":"334","author":"Venkataraman","year":"2021","journal-title":"Atherosclerosis"},{"key":"2026091603502642000_13.2.e004136.38","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1093\/eurjpc\/zwae026","article-title":"Influence of repeated plaque visualization on cardiovascular risk reduction after 3 years: a randomized controlled trial","volume":"32","author":"Whitmore","year":"2025","journal-title":"Eur J Prev Cardiol"},{"key":"2026091603502642000_13.2.e004136.39","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2011.1326"},{"key":"2026091603502642000_13.2.e004136.40","doi-asserted-by":"crossref","DOI":"10.1038\/s41746-024-01423-y","article-title":"Impact of visual presentation of atherosclerotic carotid plaque on cardiovascular risk profile using mHealth technologies","volume":"8","author":"Ullrich","year":"2025","journal-title":"NPJ Digit Med"},{"key":"2026091603502642000_13.2.e004136.41","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.01.019"},{"key":"2026091603502642000_13.2.e004136.42","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.029652"},{"key":"2026091603502642000_13.2.e004136.43","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2020.04.010"},{"key":"2026091603502642000_13.2.e004136.44","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyi060"},{"key":"2026091603502642000_13.2.e004136.45","doi-asserted-by":"publisher","DOI":"10.1136\/jech.56.3.167"},{"key":"2026091603502642000_13.2.e004136.46","doi-asserted-by":"publisher","DOI":"10.1093\/ntr\/ntn010"},{"key":"2026091603502642000_13.2.e004136.47","unstructured":"Kallings LV . Validering av socialstyrelsens indikatorfr\u00e5gor om fysisk aktivitet. Gymnastik- och Idrottsh\u00f6gskolan (GIH)\/Socialstyrelsen."},{"key":"2026091603502642000_13.2.e004136.48","doi-asserted-by":"crossref","DOI":"10.1016\/j.ajpc.2024.100635","article-title":"Healthy lifestyle, statin, and mortality in people with high CVD risk: A nationwide population-based cohort study","volume":"17","author":"Peng","year":"2024","journal-title":"Am J Prev Cardiol"},{"key":"2026091603502642000_13.2.e004136.49","doi-asserted-by":"crossref","unstructured":"Wennstig A , Hult A , Sjalander S , et al . The effect of personalized pictorial-based information about atherosclerosis on adherence to lifestyle recommendations: results from the VIPVIZA study. Eur J Prev Cardiol 2025;32. doi:10.1093\/eurjpc\/zwaf236.178","DOI":"10.1093\/eurjpc\/zwaf236.178"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2026-004136","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T10:50:52Z","timestamp":1789555852000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2026-004136"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":49,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,7,23]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/openhrt-2026-004136"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2026-004136","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}