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

Wister, Andrew; Loewen, Nadine; Kennedy-Symonds, Holly; McGowan, Brian; McCoy, Bonnie; Singer, Joel

doi:10.1503/cmaj.061059

Cited by 123 publications

(178 citation statements)

References 24 publications

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“…It has been reported that behavior change or an improvement in surrogate risk markers can be achieved through health counseling over a short period. [12][13][14] Although there is scant evidence regarding the effects of such programs in the long term or their effectiveness in disease prevention, the MHLW has decided to introduce a nationwide health screening and health counseling program commencing April 2008.…”

Section: Discussionmentioning

confidence: 99%

The Japanese National Health Screening and Intervention Program Aimed at Preventing Worsening of the Metabolic Syndrome

et al. 2008

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SUMMARYSimilar to the healthcare systems in other industrialized countries, the Japanese healthcare system is facing the problem of increasing medical expenditure. In Japan, this situation may be primarily attributed to advanced technological developments, an aging population, and increasing patient demand. Japan also faces the problem of a declining youth population due to a low birth rate. Taken together, these problems present the healthcare system with a very difficult financial situation. Several reforms have been undertaken to contain medical expenditure, such as increasing employee copayment for health insurance from 10% to 20% in 1997 and from 20% to 30% in 2003 in order to curb unnecessary visits to medical institutions. Since the aging of the Japanese population is inevitable, a suitable method to contain medical expenditure may be to screen individuals who are likely to develop lifestyle-related diseases and conduct early intervention programs for them to prevent the development of diseases such as myocardial infarction or stroke that are costly to treat. If this goal is attained, it may contribute to the containment of medical expenditure as well as to improving the quality of life of the elderly. Therefore, the Japanese Ministry of Health, Labor and Welfare has decided to introduce a nationwide health screening and intervention program specifically targeting the metabolic syndrome commencing April 2008. Here, we discuss (1) the background of the Japanese healthcare system and the problems facing it, (2) the underlying objective and details of the new screening program, and (3) the expected impact of the program. (Int Heart J 2008; 49: 193-203)

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Section: Discussionmentioning

confidence: 99%

The Japanese National Health Screening and Intervention Program Aimed at Preventing Worsening of the Metabolic Syndrome

et al. 2008

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“…Other CVD primary prevention studies achieved larger effects but required greater resources, and many included multiple contacts with clinicians. 8,10,11,[21][22][23][24] If a measurable positive effect of a more limited intervention like ours can be accomplished at a sufficiently low cost, it may be a worthwhile approach to adopt. If the process of delivering these messages can be fully automated (such as using a patient portal connected to the electronic health record), this may reduce the cost of providing this service further.…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies with repeated exposure to risk messages and counseling have shown the most favorable results. 8,10,11,22,23 An additional study is needed to examine whether repeated delivery increases efficacy.…”

Section: Discussionmentioning

confidence: 99%

Electronic Health Record-Based Patient Identification and Individualized Mailed Outreach for Primary Cardiovascular Disease Prevention: A Cluster Randomized Trial

et al. 2012

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BACKGROUND: Many individuals at higher risk for cardiovascular disease (CVD) do not receive recommended treatments. Prior interventions using personalized risk information to promote prevention did not test clinic-wide effectiveness. OBJECTIVE AND DESIGN: To perform a 9-month cluster-randomized trial, comparing a strategy of electronic health record-based identification of patients with increased CVD risk and individualized mailed outreach to usual care. PARTICIPANTS: Patients of participating physicians with a Framingham Risk Score of at least 5 %, lowdensity lipoprotein (LDL)-cholesterol level above guideline threshold for drug treatment, and not prescribed a lipid-lowering medication were included in the intention-to-treat analysis. INTERVENTION: Patients of physicians randomized to the intervention group were mailed individualized CVD risk messages that described benefits of using a statin (and controlling hypertension or quitting smoking when relevant). MAIN MEASURES: The primary outcome was occurrence of a LDL-cholesterol level, repeated in routine practice, that was at least 30 mg/dl lower than prior. A secondary outcome was lipid-lowering drug prescribing. Clinicaltrials.gov identifier: NCT01286311. KEY RESULTS: Fourteen physicians with 218 patients were randomized to intervention, and 15 physicians with 217 patients to control. The mean patient age was 60.7 years and 77% were male. There was no difference in the primary outcome (11.0 % vs. 11.1 %, OR 0.99, 95 % CI 0.56-1.74, P=0.96), but intervention group patients were twice as likely to receive a prescription for lipid-lowering medication (11.9 %, vs. 6.0 %, OR 2.13, 95 % CI 1. 05-4.32, p=0.038). In post hoc analysis with extended follow-up to 18 months, the primary outcome occurred more often in the intervention group (22.5 % vs. 16.1 %, OR 1.59, 95 % CI 1.05-2.41, P=0.029). CONCLUSIONS: In this effectiveness trial, individualized mailed CVD risk messages increased the frequency of new lipid-lowering drug prescriptions, but we observed no difference in proportions lowering LDL-cholesterol after 9 months. With longer follow-up, the intervention's effect on LDL-cholesterol levels was apparent.

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“…Brief clinical interventions increase the probability of a patient adhering to lifestyle changes, even for addictive behaviours such as smoking and problem alcohol consumption (37,38), and more comprehensive interdisciplinary care approaches are more effective (34,(39)(40)(41)(42). Because few Canadians change their lifestyle after a diagnosis of hypertension, it is important that health care professionals assist people in implementing lifestyle interventions (4).…”

Section: How Do I Optimally Reduce Cardiovascular Risk In My Patients?mentioning

confidence: 99%

The 2007 Canadian Hypertension Education Program recommendations: The scientific summary – an annual update

Campbell

2007

Canadian Journal of Cardiology

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

Cited by 123 publications

References 24 publications

The Japanese National Health Screening and Intervention Program Aimed at Preventing Worsening of the Metabolic Syndrome

The Japanese National Health Screening and Intervention Program Aimed at Preventing Worsening of the Metabolic Syndrome

Electronic Health Record-Based Patient Identification and Individualized Mailed Outreach for Primary Cardiovascular Disease Prevention: A Cluster Randomized Trial

The 2007 Canadian Hypertension Education Program recommendations: The scientific summary – an annual update

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