Key result
Dietary counseling fails to improve 10-year cardiovascular risk scores compared to usual care.
Why the study?
Dietary counseling is not yet widely implemented in health care for patients with cardiovascular disease despite evidence that a healthy diet improves cardiovascular risk factors.
Does 6 months of dietary counseling by a dietitian improve the composite 10-year cardiovascular risk prediction score in patients with established cardiovascular disease?
RCT (n=124)
Open-label
Block randomization with variable block sizes (4, 6, 8)
Yes
Does 6 months of dietary counseling by a dietitian improve the composite 10-year cardiovascular risk prediction score in patients with established cardiovascular disease?
Mean Difference: 0.6 (95% CI -4.1–5.3)
A 6-month dietary counseling program did not significantly reduce the 10-year cardiovascular risk score in patients with established cardiovascular disease, possibly due to already high baseline diet quality.
Dietary counseling does not improve 10-year CV risk scores in established CVD; challenges routine dietitian referral and supports trials of intensified or combined interventions.
BACKGROUND & AIMS: A healthy diet improves cardiovascular disease (CVD) risk factors. However, dietary counseling is not yet widely implemented in health care for patients with CVD. We assessed how dietary counseling by a dietitian, focused on improving diet quality, influenced the cardiovascular risk profile of patients with CVD. METHODS: In this 6-month trial, 124 patients with CVD (68.1 ± 9.5 years, 72 % men) were randomly assigned to counseling by a dietitian (n = 63) or usual care (n = 61). Difference in cardiovascular risk profile between groups was assessed with a 10-year composite cardiovascular risk prediction score including changes in blood pressure and low-density lipoprotein cholesterol (LDL-C). Secondary outcomes included adherence to a healthy diet as assessed with the Dutch Healthy Eating Index-2015 (DHD15-index), individual risk factors (LDL-C, blood pressure, body weight, and high-sensitivity C-reactive protein [hs-CRP]) as well as depressive symptoms and optimism scores. RESULTS: DHD15-index at baseline was 103 ± 18 out of 160 and increased 5.7 points more in the dietary counseling group compared to the usual care group (95 % confidence interval (CI): 1.3; 10.1). Multivariate analysis revealed no statistically significant differences in changes over time in 10-year cardiovascular risk score (0.6 %, 95%CI: -4.1 %; 5.3 %), blood pressure (-2 mmHg, 95%CI: -7; 4), LDL-C (0.0 mmol/l, 95%CI: 0.2; 0.2), body weight (-0.7 kg, 95%CI: -2.9; 1.5), hs-CRP (0.71 mg/dl, 95%CI: -1.20; 2.62) or depressive symptoms and optimism scores between groups. CONCLUSIONS: Dietary counseling for patients with CVD for 6 months only slightly improved adherence to a healthy diet in patients with established CVD and did not result in substantial improvement in cardiovascular risk profile or depressive symptoms and optimism scores. CLINICAL TRIAL REGISTRATION: This trial was registered at www. CLINICALTRIALS: gov/study/NCT05071092.
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Damme et al. (2024) conducted an RCT in Cardiovascular disease (n=124). Dietary counseling by a dietitian vs. Usual care was evaluated on Change in 10-year composite cardiovascular risk prediction score (SMART2 Risk Score) over 6 months (MD 0.6%, 95% CI -4.1 to 5.3). Dietary counseling for 6 months did not result in a statistically significant improvement in the 10-year composite cardiovascular risk prediction score (mean difference 0.6%) compared to usual care in patients with established cardiovascular disease.
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