Effectiveness of an Intervention Aimed at Improving Information for Patients with High Cardiovascular Risk: INFORISK Clinical Trial

Brotons, Carlos; Moral, Irene; Fernández, Diana; Puig, Mireia; Vilella, Marta Beltran; Puig, Teresa; Cuixart, Lluís; Férriz, Gemma; Pedro, Anna M.; Codinachs, Roger; Rodríguez, Mónica; Fuentes, Rubén

doi:10.3390/ijerph18073621

Cited by 4 publications

(7 citation statements)

References 24 publications

(28 reference statements)

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“…The 29 studies included in the review met the quality benchmarks outlined in the criteria selected from the JBI critical appraisal checklists. Fourteen studies 39–52 met quasi-experimental criteria 1, 2, 3, 5, 7, and 8 (Table 1), while the remaining 15 studies 53–67 met RCT criteria 3, 6, 7, 9, 10, and 11 (Table 2). In the study protocol, 28 these criteria were deemed to be critical in ensuring the methodological rigor of the studies included in the review.…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-nine studies with a total sample of 5490 adults who were free of CVD at baseline were included: 15 RCTs (n=3605), and 14 quasi-experimental studies (n=1885). The studies were conducted in the United States, 39,41,52,58,60 Canada, 53 Europe, 40,43–46,49–51,54–57,59,61,62,64,66,67 Asia, 42,47,48 Mexico, 65 and Australia 63 …”

Section: Resultsmentioning

confidence: 99%

“…Six validated absolute CVD risk assessment tools were used to measure the study outcomes, including Framingham (7 RCTs 56–58,60,65–67 and 10 quasi-experimental studies 39–41,44–50 ), SCORE (1 RCT 64 and 2 quasi-experimental studies 43,51 ), Heart Health Risk Assessment Score (1 quasi-experimental study 52 ), Dundee (1 RCT 54 ), ASSIGN (2 RCTs 55,67 ), and The UK Prospective Diabetes Study (UKPDS) risk score (4 RCTs 59,61–63 and 1 quasi-experimental study 42 ). Total sample sizes per study ranged from 12 to 711 participants.…”

Section: Resultsmentioning

confidence: 99%

“…Lastly, there were 3 RCTs that did not fit in any of the aforementioned categories. One was focused on motivational interviewing and problem-solving, 64 the second focused on health education and peer support, 63 while the last focused on tailored health education 67 . All had 12 months of follow-up and reported no significant difference in absolute CVD risk between the intervention vs control group, as outlined in Table 3.…”

Section: Resultsmentioning

confidence: 99%

“…Only the Framingham algorithms were consistently used in studies with comparable design. Of the 7 RCTs 56–58,60,65–67 that employed the Framingham algorithms, the lifestyle intervention groups had an overall average absolute CVD risk score that was 1.40 lower that of the control (mean difference= –1.40, 95% CI: –2.19, –0.61; I 2 = 47; Figure 13).…”

Section: Resultsmentioning

confidence: 99%

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Impact of lifestyle-based interventions on absolute cardiovascular disease risk: a systematic review and meta-analysis

Kariuki

Imes

Engberg

et al. 2023

JBI Evidence Synthesis

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Objective: The objective of the review was to synthesize the evidence on the effectiveness of lifestyle-based interventions in mitigating absolute cardiovascular disease (CVD) risk. Introduction: Evidence-based guidelines recommend employing an absolute CVD risk score to inform the selection and intensity of preventive interventions. However, studies employing this strategy have reported mixed results, hence the need for a systematic review of the current evidence. Inclusion criteria: Studies published in English including a lifestyle-based intervention to mitigate CVD risk that enrolled individuals aged ≥18 years, with no history of CVD at baseline were considered. The primary outcome was change in absolute CVD risk score post-intervention. Methods: PubMed, Embase, and CINAHL searches were conducted from database inception to February 2022. The trial registers searched included Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov. Searches for unpublished studies/gray literature were conducted in ProQuest Dissertations and Theses Global, GreyLit Report, and OCLC First Search Proceedings. Two independent reviewers selected the studies and critically appraised them for methodological quality using JBI tools. Data extraction was performed for main outcome variables. Data were presented using separate pooled statistical meta-analysis for quasi-experimental and randomized clinical trials. Random effects models were employed in the analyses. Effect sizes (Cohen’s d) were expressed as standardized mean difference at 95% CI. Heterogeneity was assessed via Cochran’s Q statistic, and the inconsistency index (I 2) was used to describe variability in effect estimates due to heterogeneity rather than sampling error. Results: Twenty-nine studies with a total sample of 5490 adults free of CVD at baseline were included: Fifteen were RCTs (n=3605), and 14 quasi-experimental studies (n=1885). The studies were conducted in the United States (n=5), Canada (n=1), Europe (n=18), Asia (n=3), Mexico (n=1), and Australia (n=1) and included the following lifestyle interventions: diet, physical activity, motivational interviewing, problemsolving, psychological counseling, cardiovascular risk assessment and feedback, health self-management education, and peer support. Six validated absolute CVD risk assessment tools were used to measure the study outcomes including Framingham, SCORE, Heart Health Risk Assessment Score, Dundee, ASSIGN, and The UK Prospective Diabetes Study risk score. Overall, the methodological rigor of the RCTs and quasi-experimental studies was high. Of the 15 RCTs included in the meta-analysis, lifestyle intervention was favored over control in reducing absolute CVD risk score (P=0.032; Cohen’s d = -0.39; Z= -2.14; I 2 = 96). Similarly, in the 14 quasi-experimental studies, the absolute CVD risk score after lifestyle intervention was significantly lower compared to baseline (P<0.001; Cohen’s d = -0.39; Z= -3.54; I 2 = 88). RCTs that combined diet and physical activity reported no significant impact on absolute CVD risk score, but those that used either intervention independently reported significant improvement in the absolute CVD risk score. Conclusions: There is evidence supporting the positive impact of lifestyle modification on absolute CVD risk score in adult populations free of CVD. Our analysis further suggests that diet and physical activity had significant impact on absolute CVD risk, and a variety of validated screening tools can be used to monitor, evaluate, and communicate changes in absolute risk score after lifestyle modification. Supplemental Digital Content: A Spanish-language version of the abstract of this review is available [http://links.lww.com/SRX/A29].

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Section: Resultsmentioning

confidence: 99%