Reduced Cardiovascular Disease Incidence With a National Lifestyle Change Program

Abstract

Introduction Lifestyle change programs implemented within healthcare systems could reach many Americans, but their impact on cardiovascular disease (CVD) remains unclear. The MOVE! program is the largest lifestyle change program implemented in a healthcare setting in the U.S. This study aimed to determine whether MOVE! participation was associated with reduced CVD incidence. Methods This retrospective cohort study, analyzed in 2013–2015, used national Veterans Health Administration databases to identify MOVE! participants and eligible non-participants for comparison (2005–2012). Patients eligible for MOVE!—obese or overweight with a weight-related health condition, and no baseline CVD—were examined (N=1,463,003). Of these, 169,248 (12%) were MOVE! participants. Patients were 92% male, 76% white, with mean age 52 years and BMI of 32. The main outcome was incidence of CVD (ICD-9 and procedure codes for coronary artery disease, cerebrovascular disease, peripheral vascular disease, and heart failure). Results Adjusting for age, race, sex, BMI, statin use, and baseline comorbidities, over a mean 4.9 years of follow-up, MOVE! participation was associated with lower incidence of total CVD (hazard ratio [HR]=0.83, 95% CI=0.80, 0.86), coronary artery disease (HR=0.81, 95% CI=0.77, 0.86), cerebrovascular disease (HR=0.87, 95% CI=0.82, 0.92), peripheral vascular disease (HR=0.89, 95% CI=0.83, 0.94), and heart failure (HR=0.78, 95% CI=0.74, 0.83). The association between MOVE! participation and CVD incidence remained significant when examined across categories of race/ethnicity, BMI, diabetes, hypertension, smoking status, and statin use. Conclusions Although participation was limited, MOVE! was associated with reduced CVD incidence in a nationwide healthcare setting.

Tobacco smoking and the risk of heart failure: A systematic review and meta-analysis of prospective studies

“…Ten studies 15,18,21–24,26,28,32,35 were included in the analysis of current versus never smokers and heart failure (57,180 cases, 3,810,606 participants), nine studies 15,18,21–23,26,28,32,35 were included in the analysis of former smokers and heart failure (57,004 cases, 3,803,792 participants) and 10 studies 15,18,21–23,26–28,32,33 were included in the analysis of ever smokers and heart failure (57,021 cases, 3,833,903 participants). The summary RR (95% CI) was 1.75 (95% CIs: 1.54–1.99, I 2 = 81.4%, P heterogeneity < .0001) (Figure 2(a)) for current smokers, 1.16 (95% CI: 1.08–1.25, I 2 = 50.5%, P heterogeneity = .04) for former smokers (Figure 2(b)) and 1.44 (95% CI: 1.34–1.55, I 2 = 82.5%, P heterogeneity < .0001) for ever smokers (Figure 2(c)).…”

“…Tobacco smoking is an established risk factor for coronary heart disease and stroke, as well as a wide range of other conditions, 7 and was estimated to cause 6.4 million deaths globally in 2015. 8 An increasing body of evidence also suggests that tobacco smoking is a risk factor for heart failure, 9–35 with few studies showing no association. 36,37 Although evidence of an increased risk is quite consistent, some variation in the strength of the association between smoking and heart failure has been observed, with relative risk (RR) ranging between 1.00 and 2.35.…”

“…36,37 Although evidence of an increased risk is quite consistent, some variation in the strength of the association between smoking and heart failure has been observed, with relative risk (RR) ranging between 1.00 and 2.35. 9–37 Reasons for some of the variation in effect sizes may include low statistical power in some studies, differences in the confounders and mediators adjusted for, differences in the duration of follow-up and geographic location of the studies, as well as differences in the definition of non-smokers (never smokers vs. non-current smokers) or simply chance variation. Data regarding heart failure were not included among the smoking-related conditions in the last assessment from the Global Burden of Disease Study, 8 possibly because the evidence has not been comprehensively assessed previously.…”

Random plasma glucose predicts the diagnosis of diabetes

“…All laboratory determinations were performed by the clinical chemistry laboratories at the VHA facilities where subjects were receiving care; inpatient determinations and outpatient determinations on the days of hospital admission and discharge were excluded. CVD at baseline was assessed according to use of ICD-9 diagnosis and procedure codes [12]. CVD risk factors included body mass index (BMI, kg/m 2 ), systolic blood pressure (SBP, mmHg), and non-high density lipoprotein cholesterol levels (non-HDL cholesterol, mg/dl); if more than one measurement was available, values closest to patient visits were taken.…”

Association of Food Access, Recreational Opportunities, and Natural Amenities with Engagement in the Veterans MOVE! Weight Management Program

“…Maintaining engagement continues to be a major challenge not only to MOVE! but also to nearly all weight management programs, regardless of program effectiveness .…”