Family-based approach improves CVD prevention

Medical Tribune August 2008 P10
David Brill

Standards of cardiovascular disease prevention in primary care can be improved by implementing a multidisciplinary family-based programme, an international study published in The Lancet has shown.

Patients who took part in the EUROACTION trial – the largest research project ever carried out by the European Society of Cardiology – demonstrated improvements in their diet, physical activity levels and smoking status a year later.

They were also more likely to have better control of cholesterol levels and to achieve blood pressure targets, without an increase in the use of antihypertensive drugs.

Many of the healthy lifestyle changes achieved by the patients extended to their partners, who were also targeted by the programme.

The active involvement of family members in EUROACTION is a big step forward for preventive cardiology, according to Professor David Wood of Imperial College London, who led the study.

“Often the person responsible for the shopping and cooking is not the patient so to make dietary changes they need to be made in the family as a whole. And that’s what we achieved – we saw the same direct changes in the partners as in the patients,” he said, adding that similar family-wide effects were observed for smoking and physical activity.

Dr. Shyamala Thilagaratnam from the Health Promotion Board in Singapore said that: “The results indicate very encouraging effects of an intensive intervention programme for cardiovascular disease prevention.

“A supportive home environment is an important determinant of successful lifestyle behavioural modification,” she said, adding that a similar approach to that seen in the study could be considered for local programmes.

EUROACTION was conducted across 8 European countries with a range of different health economies.

“We were able to fit in with whatever was available on the ground, which means that our programme could be implemented in any comparable healthcare setting,” said Wood.

He added that the trial was intentionally carried out in “hard-working” hospitals and general practices in order to ensure that the results were generalizable.

EUROACTION involved 2,317 patients recruited from general practices who were asymptomatic but at high-risk for developing cardiovascular disease, and 3,088 hospital patients with established coronary heart disease. [Lancet 2008 Jun 14;371:1999-2012]

Each group was randomized to receive usual care or participate in the study intervention, which involved an initial assessment and regular follow-up meetings with a dietician, a physiotherapist and a specially-trained nurse. Patients and their partners were encouraged to work towards pre-specified goals for lifestyle change, and were reassessed a year later.

“The issue of cardiovascular risk assessment is now central to primary prevention,” concluded Wood.

“For general practitioners the first challenge is to identify the high-risk people in their practice and then the second challenge is to manage that risk. That’s where the EUROACTION program provides an evidence base and a practical approach.”