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One-year follow-up of a therapeutic lifestyle intervention targeting cardiovascular disease risk

From the Department of Gerontology (Wister), Simon Fraser University; Fraser Health (Loewen); Acute Care and Special Projects, Burnaby Hospital, Fraser Health (Kennedy-Symonds); Emergency Medicine, Burnaby Hospital, Fraser Health (McGowan), Burnaby, BC; Centre for Health Economics in Cancer, BC Cancer Research Centre (McCoy); Department of Health Care and Epidemiology (Singer), University of British Columbia, Vancouver, BC

Correspondence to: Dr. Andrew V. Wister, Professor and Chair, Department of Gerontology, Simon Fraser University, Vancouver Campus, 2800–515 W Hastings St., Vancouver BC V6B 5K3; fax 604 291-5066; wister{at}sfu.ca

Background: In this study, we tested the efficacy of a low-intensity lifestyle intervention aimed at reducing the risk of cardiovascular disease among mid-life individuals.

Methods: We conducted a randomized controlled trial in which participants were randomly assigned either to receive a health report card with counselling (from a Telehealth nurse) on smoking, exercise, nutrition and stress or to receive usual care. The patients were divided into 2 groups on the basis of risk: the primary prevention group, with a Framingham risk score of 10% or higher (intervention, n = 157; control, n = 158), and the secondary prevention group, who had a diagnosis of coronary artery disease (intervention, n = 153; control, n = 143). The primary outcome was a change in the Framingham global risk score between baseline and 1-year follow-up. Data were analyzed separately for the 2 prevention groups using an intention-to-treat analysis controlling for covariates.

Results: Within the primary prevention group, there were statistically significant changes for the treatment group relative to the controls, from baseline to year 1, in Framingham score (intervention, –3.10 [95% confidence interval (CI) –3.98 to –2.22]; control, –1.30 [95% CI –2.18 to –0.42]; p < 0.01) and scores for total cholesterol (intervention, –0.41 [95% CI –0.59 to –0.23]; control, –0.14 [95% CI –0.32 to 0.04]; p < 0.05), systolic blood pressure (intervention, –7.49 [95% CI –9.97 to –5.01]; control, –3.58 [95% CI –6.08 to –1.08]; p < 0.05), nutrition level (intervention, 0.30 [95% CI 0.13 to 0.47]; control, –0.05 [95% CI –0.22 to 0.12]; p < 0.01), and health confidence (intervention, 0.20 [95% CI 0.09 to 0.31]; control, 0.04 [95% CI –0.07 to 0.15]; p < 0.05), with adjustment for covariates. No significant changes in outcome variables were found for the secondary prevention group.

Interpretation: We found evidence for the efficacy of an intervention addressing multiple risk factors for primary prevention at 1 year using Framingham risk score report cards and telephone counselling. (Requirement for clinical trial registration waived [enrolment completed before requirement became applicable].)

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