Mahesh J. Patel, MD; L. Kristin Newby, MD, MHS
In adults without coronary heart disease (CHD), do interventions using counseling and educational methods that target multiple cardiovascular (CV) risk factors reduce mortality?
Included studies assessed counseling or educational interventions (with or without pharmacologic treatments) that aimed to alter > 1 CV risk factor, had a mean patient age ≥ 35 years, and had ≤ 25% of patients with evidence of CHD. Outcomes included mortality, fatal CHD, and fatal stroke events.
MEDLINE (1966 to Apr 1995, 2000 to Jun 2006), EMBASE/Excerpta Medica (1998 to Jun 2006), Cochrane Central Register of Controlled Trials (Issue 2, 2006), and reference lists were searched for randomized controlled trials (RCTs) with a parallel-group design and ≥ 6 months of follow-up. Mortality and event rate follow-up data were updated when subsequently published. 55 RCTs (n = 163 471, mean age 50 y), with a median follow-up of 1 year, met the selection criteria. Interventions included workshops, lectures, personal counseling, written material, assignments, cooking sessions, and shopping tours; some required participation of family members. Control treatment was usual care or was not described. Outcome assessors were blinded in 12 trials.
Fewer patients in the intervention group died of stroke (Table). Groups did not differ for all-cause or CHD mortality (Table). Subgroup analysis showed that the intervention reduced all-cause mortality in RCTs involving patients with hypertension or diabetes (relative risk reduction 20%, 95% CI 10 to 29).
In adults without coronary heart disease, interventions that target multiple cardiovascular risk factors reduce stroke mortality but not all-cause or coronary heart disease mortality.
Interventions that target multiple cardiovascular risk factors vs control in adults without coronary heart disease (CHD)*
*Abbreviations defined in Glossary. RRR, NNT, and CI calculated from control event rates, risk ratios, and risk differences in article.
Patel MJ, Newby LK. Review: Counseling and educational methods that target multiple CV risk factors do not reduce mortality in adults without CHD. Ann Intern Med. 2011;154:JC6–4. doi: 10.7326/0003-4819-154-12-201106210-02004
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Published: Ann Intern Med. 2011;154(12):JC6-4.
Cardiology, Coronary Risk Factors, Prevention/Screening.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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