Key result
In multivariate analyses, the addition or dose change of lipid-lowering and antihypertensive medications, along with a higher baseline SCORE, were the only factors significantly related to a successful reduction in estimated 10-year cardiovascular mortality risk.
Why the study?
Does additional self-monitoring improve cardiovascular risk score reduction in general practice patients with mild-moderately elevated cardiovascular risk?
RCT (n=179)
Open-label
Randomized
Yes
Does additional self-monitoring improve cardiovascular risk score reduction in general practice patients with mild-moderately elevated cardiovascular risk?
Absolute Event Rate: -1.79% vs -1.63%
Baseline cardiovascular risk and changes in lipid-lowering or antihypertensive medications are the primary drivers of successful cardiovascular risk score reduction in general practice.
Medication changes and higher baseline SCORE drove reductions; leaves open optimal non-pharmacologic strategies in primary care.
BACKGROUND: Cardiovascular disease is a leading cause of death. It is important to identify patient and treatment factors that are related to successful cardiovascular risk reduction in general practice. This study investigates which patient and treatment factors are related to changes in cardiovascular risk estimation, expressed as the Systematic Coronary Risk Evaluation (SCORE) 10 year risk of cardiovascular mortality. METHODS: 179 general practice patients with mild-moderately elevated cardiovascular risk followed a one-year programme which included structured lifestyle and medication treatment by practice nurses, with or without additional self-monitoring. From the patient and treatment data collected as part of the "Self-monitoring and Prevention of RIsk factors by Nurse practitioners in the region of Groningen" randomized controlled trial (SPRING-RCT), the contribution of patient and treatment factors to the change in SCORE was analysed with univariate and multivariate analyses. RESULTS: In multivariate analyses with multiple patient and treatment factors, only SCORE at baseline, and addition of or dose change in lipid lowering or antihypertensive medications over the course of the study were significantly related to change in SCORE. CONCLUSIONS: Our analyses support the targeting of treatment at individuals with a high SCORE at presentation. Lipid lowering medication was added or changed in only 12% of participants, but nevertheless was significantly related to ΔSCORE in this study population. Due to the effect of medication in this practice-based project, the possible additional effect of the home monitoring devices, especially for individuals with no indication for medication, may have been overshadowed. TRIAL REGISTRATION: trialregister.nl NTR2188.
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Tiessen et al. (2013) conducted an RCT in Mild-moderately elevated cardiovascular risk (n=179). Structured lifestyle and medication counselling with self-monitoring (home blood pressure, weighing scale, pedometer) vs. Standard structured lifestyle and medication counselling without self-monitoring was evaluated on Mean change in SCORE 10-year risk of fatal CVD. In multivariate analyses, the addition or dose change of lipid-lowering and antihypertensive medications, along with a higher baseline SCORE, were the only factors significantly related to a successful reduction in estimated 10-year cardiovascular mortality risk.
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