A lifestyle intervention for preventing cardiovascular disease

Cardiovascular disease remains the leading cause of death in Canada and elsewhere, accounting for 36% of all deaths in this country. The total cost of cardiovascular disease to the health care system in 1998 was estimated at nearly $18.5 million, which accounts for a striking 11.6% of the costs of all illnesses. Although age-adjusted mortality rates for cardiovascular disease have fallen modestly over the past 3 decades, the absolute number of people with cardiovascular disease or related heart problems will continue to rise as the baby boom generation ages.

Effective prevention and risk reduction programs for cardiovascular disease tend to be multidisciplinary interventions with self-care components tailored to individual risk factors.

These programs use evidence-based recommendations for prevention linked to lipid levels, blood pressure, glucose levels and various aspects of lifestyle, including smoking cessation, physical activity, weight management, nutrition and stress management. Typically, they employ what has been called the “expert patient model,” an approach that teaches people how to identify and reach health behaviour goals through a combination of self-direction and professional support. However, cardiovascular risk reduction programs often require significant health care resources, they do not incorporate long-term maintenance ofbehaviour change and follow-up, and they have not been developed with a view to reaching a wide at-risk population.

In response to these research gaps, this project was designed to test the efficacy of the “Simon Fraser Heart Health Report Card System,” which employs the Framingham risk scoring methodology to measure global cardiovascular risk levels and to identify targets, which are then distributed in an annual report card to participants and their physicians. The report card was coupled with evidence-based prevention knowledge aimed at motivating participants to change their risk factors through a Telehealth counselling approach.

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 n= 153; control, n=coronary artery disease (intervention, 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.