Factors Influencing Physician Counseling on Cardiovascular Risk.

Area of Science:

• Cardiology
• Preventive Medicine
• Health Behavior Research

Background:

• Cardiovascular disease (CVD) mortality can be significantly reduced through aggressive management of modifiable risk factors.
• Patients at increased risk for CVD require standard pharmacotherapy alongside lifestyle behavioral change counseling.

Purpose of the Study:

• To identify patient factors influencing physician provision of cardiovascular risk reduction counseling.
• To determine the frequency of such counseling in high-risk populations.

Main Methods:

• Secondary analysis of a prospective, randomized trial involving 388 underserved inner-city and rural individuals with a 10% or greater 10-year CVD risk.
• Quarterly assessments over 1 year evaluated weight, blood pressure, lipid, and glucose status.
• Patients were queried at each visit about physician discussions or recommendations on diet, weight loss, and exercise.

Main Results:

• The average patient was 61.3 years old with an average BMI of 31.8 kg/m2, blood pressure of 146/82 mm Hg, A1c of 6.7%, and total cholesterol of 201 mg/dL.
• Logistic regression analysis revealed that only body mass index (BMI) was significantly associated with physician lifestyle counseling (P < .025).
• Other clinical risk factors showed no statistical relationship with counseling provision.

Conclusions:

• Body mass index (BMI) is the primary clinical factor influencing physician counseling on nutrition and weight loss.
• Physicians may be overlooking crucial opportunities to impact behavior in high-risk CVD patients by focusing solely on obesity.