Cardiovascular is a major cause of mortality and morbidity and its prevalence is set to increase

Abstract

Cardiovascular is a major cause of mortality and morbidity and its prevalence is set to increase. While the benefits of medical and lifestyle interventions is established, the effectiveness of interventions which seek to improve the way preventive care is delivered in primary care is less so. The purpose was to study the effectiveness of 2 intervention programs in reducing cardiovascular risk factors within primary care. Methods: A randomized controlled trial conducted in Belgium 2007-2010 with 295 participants allocated to a medical (=MP) and a medical + behavioral (=MBP) program. The MP consisted of medical assessments (screening and follow-up) by a general practitioner. The BP was a tailored behavior change program (web-based and individual coaching). The dose of the coaching was chosen by the participants. Primary outcome measures were total cholesterol, blood pressure, and body mass index (BMI). The secondary outcomes were smoking status, fitness-score, total cardiovascular risk and events. Results: The median age was 40 years (IQR 32– 49), 75 participants were female, 6 had a personal cardiovascular event and 3 had diabetes. The median total cholesterol was 181,5 mg/dl (IQR 165 – 207), median systolic pressure 130 mmHg (IQR 120 – 140), median diastolic blood pressure 83 mmHg (IQR 75 - 90) and median BMI was 25 kg/ m² (IQR 22 - 27). Being a smoker was reported by 48 of the participants. There were no significant differences in baseline characteristics between MP and MBP. Our drop-out after three years of intervention was 13%. there was a significant decrease in total cholesterol (median difference: -4,5 mg/dl; p<0,001), systolic blood pressure (-1 mmHg; p=0,016), and diastolic blood pressure (-16,5 mmHg; p<0,001). There was a significant increase in BMI (+0,3 kg/m²; p<0,001). There were no significant differences found between MP and MBP in primary outcomes. At baseline, 48 participants were smoker compared to 29 at the study endpoint. Overall there was a significant decrease in fitness-score (median difference: -2; p=0,035). Calculation of the total cardiovascular risk for participants gave a median score of 0,35 (IQR 0,11 – 1,19) at baseline and 0,34 (IQR 0,091 – 1,11) at end-point (p<0,001). During the study period one participant in the MBP had a cardiovascular event. Conclusion: Both intervention programs are effective in reducing cardiovascular risk factors. In our population the combined medical and behavioural program was not superior to the medical program.