Lifestyle Interventions Reduce Coronary Heart Disease Risk

Abstract

Background-Although trials of lifestyle interventions generally focus on cardiovascular disease risk factors rather than hard clinical outcomes, 10-year coronary heart disease (CHD) risk can be estimated from the Framingham risk equations. Our objectives were to study the effect of 2 multicomponent lifestyle interventions on estimated CHD risk relative to advice alone and to evaluate whether differences can be observed in the effects of the lifestyle interventions among subgroups defined by baseline variables. Methods and Results-A total of 810 healthy adults with untreated prehypertension or stage I hypertension were randomized to 1 of 3 intervention groups: An "advice-only" group, an "established" group that used established lifestyle recommendations for blood pressure control (sodium reduction, weight loss, and increased physical activity), or an "established-plus-DASH" group that combined established lifestyle recommendations with the DASH (Dietary Approaches to Stop Hypertension) diet. The primary outcome was 10-year CHD risk, estimated from follow-up data collected at 6 months. A secondary outcome was 10-year CHD risk at 18 months. Of the 810 participants, 62% were women and 34% were black. Mean age was 50 years, mean systolic/diastolic blood pressure was 135/85 mm Hg, and median baseline Framingham risk was 1.9%. The relative risk ratio comparing 6-month to baseline Framingham risk was 0.86 (95% confidence interval 0.81 to 0.91, PϽ0.001) in the established group and 0.88 (95% confidence interval 0.83 to 0.94, PϽ0.001) in the established-plus-DASH group relative to advice alone. Results were virtually identical in sensitivity analyses, in each major subgroup, and at 18 months. Conclusions-The observed reductions of 12% to 14% in estimated CHD risk are substantial and, if achieved, should have important public health benefits.

Social Determinants of Risk and Outcomes for Cardiovascular Disease

“…Similarly, changes in dietary behavior (ie, reduction in calories, saturated fat, sodium), an increase in physical activity, and a 5% weight loss among high-risk individuals have been prospectively associated with a 58% reduction in the incidence of diabetes mellitus, 213 a 42% reduction in the incidence of hypertension, 214 and a 12% to 14% reduction in 10-year risk of coronary heart disease. 215 A large body of evidence indicates that differences in health behaviors account for some of the socioeconomic gradient in health. [216][217][218] However, prevention of CVD cannot be reduced to simply targeting unhealthy behaviors because behaviors are in turn affected by the socioeconomic circumstances in which individuals live (ie, social patterning of behaviors).…”

Effects of a Health‐Partner Intervention on Cardiovascular Risk

“…To this effect, various lifestyle and nonpharmacological interventions have been examined in cardiac and noncardiac patient populations and have used cognitive‐behavioral strategies, including motivational interviewing, goal setting, continued support, promotion of clinical self‐knowledge and efficacy, as well as self‐monitoring and management 2, 3, 4. These measures have been delivered by health care providers, computer programs, or online interfaces, predominantly in patients with established CVD or its risk factors 5, 6, 7, 8, 9, 10, 11…”

Cardiovascular disease prevention via a nurse-facilitated intervention clinic in a regional setting: The Protecting Healthy Hearts Program

“…In a meta-analysis of 42 studies, 25 multi-factorial lifestyle interventions in primary prevention reduced systolic BP by -3.0 mm Hg, diastolic BP by -4.2 mm Hg, total cholesterol by -0.36 mmol/l and weight by -0.9 kg. Our intervention program achieved similar results among community participants, albeit better for some risk factors, although greater improvements have been found with more rigorous interventions over longer follow-up periods in higher risk individuals [26][27][28][29] and using enhanced pharmacological management. 30,31 The lasting effects beyond the program completion are uncertain however and short-term clinically significant positive adjustments may not be sustained over the longer term 32 or indeed translate into reduced CVD morbidity and mortality 33 because of gradual degradation in risk factor profile after initial improvements are made reflecting lack of permanence in healthy lifestyle behavioral change.…”