A comprehensive lifestyle intervention program in patients with coronary heart disease reduced the calculated five-year CHD risk in males by 22% (95% CI 9-35) compared to usual care.
RCT (n=197)
Does a comprehensive lifestyle intervention programme improve lifestyle measures and reduce five-year coronary risk in patients with coronary heart disease?
A comprehensive lifestyle intervention program significantly improves diet, exercise, and smoking cessation rates in patients with coronary heart disease on modern medical therapy.
Effect estimate: RRR 22% (95% CI 9-35)
BACKGROUND: Lifestyle measures of coronary heart disease (CHD) prevention have been overshadowed by the efficacy of drug treatments. This is particularly the case in the setting of secondary prevention where the benefits of lipid lowering, anti-platelet and anti-hypertensive drugs have been emphasised in numerous trials. Lifestyle measures address several CHD risk factors at once and are generally free of serious side effects. OBJECTIVES: The objective of the present study was to determine whether a comprehensive programme of lifestyle modification could favourably influence dietary and exercise habits in addition to smoking cessation over two years. In addition, an attempt was made to evaluate if this programme could favourably influence the five-year CHD-risk in the male population included in the study. DESIGN: A total of 197 patients with proven coronary heart disease were included and randomised to a lifestyle intervention programme or to usual care. Follow-up was after a period of two years. METHODS: Intervention comprised a low fat diet, regular exercise, smoking cessation, psychosocial support and education, delivered by nurses on the rationale for pharmacological and lifestyle measures. Usual care comprised follow-up in the routine outpatient clinic. Both groups were given the same comprehensive medication according to recent guidelines. RESULTS: Patients in the lifestyle intervention group reduced the intake of saturated fat, sugar and cholesterol (P<0.001), increased their exercise level (P<0.01) and stopped smoking (P<0.05) when compared with the usual care group. A sub-analysis of the influence of five-year CHD calculated risk in males resulted in a relative risk reduction of 22% (95% confidence intervals 9-35). Although significant, this result must be interpreted with caution due to poor statistical power and reproducibility of the method. CONCLUSIONS: In the presence of modern drug treatments for secondary cardiovascular disease prevention it remains possible through a favourable diet, exercise and smoking cessation to show an additional reduction in the five-year risk for CHD in males.
Jan Erik Otterstad (Mon,) conducted a rct in Coronary heart disease (n=197). Comprehensive lifestyle intervention programme vs. Usual care was evaluated on Five-year CHD calculated risk in males (RRR 22%, 95% CI 9-35). A comprehensive lifestyle intervention program in patients with coronary heart disease reduced the calculated five-year CHD risk in males by 22% (95% CI 9-35) compared to usual care.