Lifestyle Counseling Reduces Heart Risk
FRIDAY June 13, 2008 -- An intensive, across-Europe effort to offer lifestyle advice to people at high risk of heart disease effectively helped them reduce such risk factors as high blood pressure, cholesterol and smoking.
"The results we see are very encouraging compared to what we see in usual care," said Dr. David Wood, a cardiology professor at Imperial College in London and the lead author of a report on the trial in the June 13 issue of The Lancet.
But, he added, "there is certainly room for improvement, particularly in relation to helping patients quit smoking."
The program, mainly run by nurses, was developed by the European Society of Cardiology and tested on more than 5,000 people in six pairs of hospitals and six pairs of general practice in eight countries.
"It was for two groups of patients," Wood said. "One was those who already had developed coronary heart disease, another those who were asymptomatic but at high risk because of a combination of risk factors that gives a high chance of developing heart disease over 10 years."
The trial, called the Euroaction study, compared the results of added counseling on lifestyle issues such as diet, physical activity and smoking to the usual care. It included more than 3,000 people with coronary heart disease and 2,300 at high risk. Half got the counseling from a team headed by nurses, assisted by dietitians and physiotherapists, with doctors in the background. The counseling was given to families as well as individuals.
"It was the nurses who coordinated the day-to-day program, with a comprehensive assessment of lifestyle and risk factors such as blood pressure and glucose," Wood said.
In diet, 55 percent of those getting the counseling reduced their intake of saturated fat, compared to 40 percent for those note getting the advice. Increased consumption of fruits and vegetables was seen in 72 percent of the counseled group, and 17 percent of them also increased their consumption of heart-friendly oily fish, compared to 35 percent and 8 percent in the other group.
Similar results were seen for blood pressure, cholesterol and physical activity, but it proved difficult to have people seen in general practice quit smoking, Wood said.
"But the fact that we ran it in eight countries and both in general hospitals and general practice means that we have demonstrated that this nurse-administered program is practical," he said. "We are looking at cost-effectiveness at this moment, and the early data suggest that it is cost-effective in preventing heart attack and stroke."
"What really was new here was that they actually made an effort to give the advice we know should be given but often isn't," said Dr. Dariush Mozaffarian, an assistant professor of medicine at Harvard Medical School and the Harvard School of Public Health, who wrote an accompanying comment in the journal.
While there have been many trials aimed at improving drug treatment in cardiology, "there are few trials in getting doctors and patients to concentrate on lifestyle," Mozaffarian said. "This shows that a relatively modest intervention can bring dramatic improvements in lifestyle."
However, he added, it's not clear whether such a program could be started in many U.S. hospitals and medical practices. "In principle, every physician should be doing it," he said. "But the system would have to change."
For such a program to work, Mozaffarian said, "policy makers, insurance companies and indicators of quality would have to focus on lifestyle and stimulate hospitals to put preventive measures into place."
Recommendations on a healthy diet and lifestyle are given by the American Heart Association.
Posted: June 2008