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Lifestyle Counseling Reduces Heart Risk
By Ed Edelson
HealthDay Reporter
FRIDAY, June 13 (HealthDay News) -- An intensive, across-Europe effort
to offer lifestyle advice to people at high risk of heart disease
effectively helped them reduce such risk factors as high blood
pressure, cholesterol and smoking.
"The results we see are very encouraging compared to what we see in
usual care," said Dr. David Wood, a cardiology professor at Imperial
College in London and the lead author of a report on the trial in the
June 13 issue ofThe Lancet.
But, he added, "there is certainly room for improvement, particularly in relation to helping patients quit smoking."
The program, mainly run by nurses, was developed by the European
Society of Cardiology and tested on more than 5,000 people in six pairs
of hospitals and six pairs of general practice in eight countries.
"It was for two groups of patients," Wood said. "One was those who
already had developed coronary heart disease, another those who were
asymptomatic but at high risk because of a combination of risk factors
that gives a high chance of developing heart disease over 10 years."
The trial, called the Euroaction study, compared the results of
added counseling on lifestyle issues such as diet, physical activity
and smoking to the usual care. It included more than 3,000 people with
coronary heart disease and 2,300 at high risk. Half got the counseling
from a team headed by nurses, assisted by dietitians and
physiotherapists, with doctors in the background. The counseling was
given to families as well as individuals.
"It was the nurses who coordinated the day-to-day program, with a
comprehensive assessment of lifestyle and risk factors such as blood
pressure and glucose," Wood said.
In diet, 55 percent of those getting the counseling reduced their
intake of saturated fat, compared to 40 percent for those note getting
the advice. Increased consumption of fruits and vegetables was seen in
72 percent of the counseled group, and 17 percent of them also
increased their consumption of heart-friendly oily fish, compared to 35
percent and 8 percent in the other group.
Similar results were seen for blood pressure, cholesterol and
physical activity, but it proved difficult to have people seen in
general practice quit smoking, Wood said.
"But the fact that we ran it in eight countries and both in general
hospitals and general practice means that we have demonstrated that
this nurse-administered program is practical," he said. "We are looking
at cost-effectiveness at this moment, and the early data suggest that
it is cost-effective in preventing heart attack and stroke."
"What really was new here was that they actually made an effort to
give the advice we know should be given but often isn't," said Dr.
Dariush Mozaffarian, an assistant professor of medicine at Harvard
Medical School and the Harvard School of Public Health, who wrote an
accompanying comment in the journal.
While there have been many trials aimed at improving drug treatment
in cardiology, "there are few trials in getting doctors and patients to
concentrate on lifestyle," Mozaffarian said. "This shows that a
relatively modest intervention can bring dramatic improvements in
lifestyle."
However, he added, it's not clear whether such a program could be
started in many U.S. hospitals and medical practices. "In principle,
every physician should be doing it," he said. "But the system would
have to change."
For such a program to work, Mozaffarian said, "policy makers,
insurance companies and indicators of quality would have to focus on
lifestyle and stimulate hospitals to put preventive measures into
place."
More information
Recommendations on a healthy diet and lifestyle are given by the American Heart Association.
SOURCES: David Wood, M.D., professor of cardiology, Imperial
College, London, England; Dariush Mozaffarian, M.D., assistant
professor of medicine, Harvard Medical School, Boston; June 13,
2008,The Lancet
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