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Efficacy of Mobile-Based Cognitive Behavioral Therapy on Lowering Low-density Lipoprotein Cholesterol Levels in
DuanBin Li1,2, Tian Xu3, DaQi Xie4
1Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Insights
Mobile-based cognitive behavioral therapy (CBT) effectively lowers LDL-C in atherosclerotic cardiovascular disease (ASCVD) patients. This intervention also improves self-efficacy and quality of life, even for those with already standard LDL-C levels.
Area of Science:
- Cardiology
- Behavioral Science
- Digital Health
Background:
- Elevated low-density lipoprotein cholesterol (LDL-C) is a key risk factor for atherosclerotic cardiovascular disease (ASCVD).
- Poor medication adherence and lifestyle management hinder effective lipid level reduction.
- Cognitive behavioral therapy (CBT) shows promise for improving patient adherence and outcomes.
Purpose of the Study:
- To assess the efficacy of a mobile-based CBT intervention in reducing LDL-C levels among ASCVD patients.
- To evaluate the impact of mobile CBT on general self-efficacy and quality of life.
Main Methods:
- A multicenter, prospective, randomized controlled trial involving 300 ASCVD patients.
- Intervention group received mobile-based CBT via WeChat MiniApp; control group received routine health education.
- Outcomes measured included LDL-C, triglyceride, C-reactive protein, General Self-Efficacy Scale (GSE), and quality of life index (QL-index) at 1, 3, and 6 months.
Main Results:
- Mobile-based CBT significantly reduced LDL-C levels by 6 months (β=-10.026, P<0.05), including in patients with baseline LDL-C <1.8 mmol/L.
- The intervention moderately increased LDL-C up-to-standard rates (OR=1.579, P<0.05).
- Significant improvements in GSE and QL-index scores were observed at 1, 3, and 6 months (P<.05).
Conclusions:
- Mobile-based CBT is an effective strategy for lowering LDL-C in ASCVD patients.
- The intervention enhances patient self-efficacy and quality of life.
- This digital health approach offers a viable solution for managing lipid levels and improving overall well-being in ASCVD.
Background:
Elevated low-density lipoprotein cholesterol (LDL-C) is an established risk factor for atherosclerotic cardiovascular disease (ASCVD). However, low adherence to medication and lifestyle management has limited the benefits of lowering lipid levels. Cognitive behavioral therapy (CBT) has been proposed as a promising solution.
Objective:
This trial aimed to evaluate the efficacy of mobile-based CBT interventions in lowering LDL-C levels in patients with ASCVD.
Methods:
This multicenter, prospective, randomized controlled trial enrolled 300 patients with ASCVD, who were randomly assigned to the mobile-based CBT intervention group and the control group in a ratio of 1:1. The intervention group received CBT for ASCVD lifestyle interventions delivered by WeChat MiniApp: "CBT ASCVD." The control group only received routine health education during each follow-up. The linear regression and logistic regression analyses were used to determine the effects of a mobile-based CBT intervention on LDL-C, triglyceride, C-reactive protein, the score of General Self-Efficacy Scale (GSE), quality of life index (QL-index), and LDL-C up-to-standard rate (<1.8 mmol/L) at the first, third, and sixth months.
Results:
Finally, 296 participants completed the 6-month follow-up (CBT group: n=148; control group: n=148). At baseline, the mean LDL-C level was 2.48 (SD 0.90) mmol/L, and the LDL-C up-to-standard rate (<1.8 mmol/L) was 21.3%. Mobile-based CBT intervention significantly increased the reduction of LDL-C change (%) at the 6-month follow-up (β=-10.026, 95% CI -18.111 to -1.940). In addition, this benefit remained when baseline LDL-C <1.8 mmol/L (β=-24.103, 95% CI -43.110 to -5.095). Logistic regression analysis showed that mobile-based CBT intervention moderately increased the LDL-C up-to-standard rates (<1.8 mmol/L) in the sixth month (odds ratio 1.579, 95% CI 0.994-2.508). For GSE and QL-index, mobile-based CBT intervention significantly increased the change of scores (%) at the 1-, 3-, and 6-month follow-up (all P values <.05).
Conclusions:
In patients with ASCVD, mobile-based CBT is effective in reducing LDL-C levels (even for those who already had a standard LDL-C) and can improve self-efficacy and quality of life.
Trial Registration:
Chinese Clinical Trial Registry ChiCTR2100046775; https://www.chictr.org.cn/showproj.aspx?proj=127140.
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