Related Experiment Videos
The impact of health care advice given in primary care on cardiovascular risk. CELL Study Group
L H Lindholm1, T Ekbom, C Dash
1Health Sciences Centre Dalby/Lund, University of Lund, Sweden.
Insights
Intensive health advice showed limited additional benefit for cardiovascular risk reduction compared to usual care. New communication strategies are needed for impactful primary care interventions.
Area of Science:
- Cardiovascular disease prevention
- Public health interventions
- Health behavior change
Background:
- Cardiovascular disease (CVD) poses a significant global health burden.
- Managing multiple cardiovascular risk factors is crucial for primary prevention.
- Intensive lifestyle interventions are often recommended but their effectiveness in primary care settings needs evaluation.
Purpose of the Study:
- To assess the added value of intensive, group-based health advice versus usual care for individuals with multiple CVD risk factors.
- To quantify the impact on lipid concentrations and overall cardiovascular risk scores.
Main Methods:
- A prospective, randomized controlled trial involving 681 adults (aged 30-59) with at least two CVD risk factors and elevated lipids.
- Intervention group received six intensive group health sessions; control group received usual care.
- Study duration was 18 months, with primary outcome measures including cholesterol reduction and Framingham risk score changes.
Main Results:
- The intensive advice group experienced a slightly greater reduction in total cholesterol (0.15 mmol/l) and Framingham risk score (0.068) compared to the usual care group.
- While some risk factors showed favorable changes in the intensive group, differences were often not statistically significant.
- Participant self-reported improvements in lifestyle and diet were noted following group sessions.
Conclusions:
- Intensive group health advice provided limited additional benefit in reducing cardiovascular risk within this primary care setting.
- Relying solely on practice staff for intensive interventions may not be sufficient for significant impact.
- Novel communication methods are required to enhance the effectiveness of CVD risk reduction strategies in primary care.
Objective:
To evaluate the additional benefit of "intensive" health care advice through six group sessions, compared with the advice usually offered to subjects with multiple risk factors for cardiovascular disease.
Design:
Prospective, randomised controlled clinical study lasting 18 months.
Setting:
681 subjects aged 30-59 years, with at least two cardiovascular risk factors in addition to moderately high lipid concentrations: total cholesterol > or = 6.5 mmol/l on three occasions, triglycerides < 4.0 mmol/l, and ratio of low density lipoprotein cholesterol to high density lipoprotein cholesterol > 4.0. Most (577) of the subjects were men.
Main Outcome Measure:
Percentage reduction in total cholesterol concentration (target 15%); quantification of the differences between the two types of health care advice (intensive v usual) for the Framingham cardiovascular risk and for individual risk factors.
Results:
In the group receiving intensive health care advice total cholesterol concentration decreased by 0.15 mmol/l more (95% confidence interval 0.04 to 0.26) than in the group receiving usual advice. The overall Framingham risk dropped by 0.068 more (0.014 to 0.095) in the group receiving intensive advice, and most of the risk factors showed a greater change in a favourable direction in this group than in the group receiving usual advice, but the differences were seldom significant. The results from questionnaires completed at the group sessions showed that the subjects improved their lifestyle and diet.
Conclusion:
Limited additional benefit was gained from being in the group receiving the intensive health care advice. It is difficult to make an important impact on cardiovascular risk in primary care by using only the practice staff. Better methods of communicating the messages need to be devised.