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Lifestyle advice won't change CHD outcomes

By Lilian Anekwe

Educating patients to change their lifestyle does not improve outcomes of coronary heart disease and cannot be done effectively in primary care, a major Cochrane review concludes.

UK researchers, who carried out the meta-analysis, said primary prevention programmes to modify risk factors through lifestyle changes – as recommended in the NSF for coronary heart disease – have limited, if any, impact on mortality and morbidity.

A total of 39 trials assessing the efficacy of counselling and educational programmes to tackle cardiovascular risk factors such as cholesterol, smoking, physical activity and diet in adults older than 40 were identified – 10 of which reported clinical outcomes.

The pooled effect suggested multiple risk factor intervention had no effect on mortality and any risk factor changes were modest.

Study author Andrew Bes-wick, investigator scientist at the MRC health services re-search collaboration at the University of Bristol, said: 'The evidence shows there doesn't seem to be any real or large benefits in trying to introduce multiple risk factor interventions into general practice, and it's un-likely to show great benefits.'

He added: 'A better approach may be looking at high-risk patients, and not whole populations.'

Dr John Ashcroft, CHD lead for Erewash PCT and a GP in Ilkeston, Derbyshire, said: 'We are far better off spending our time talking to patients about aspirin or statins, or telling them to look at their blood pressure or stop smoking, than banging on about lifestyle factors.'

Dr Ashcroft added: 'Even in controlled trials with motivated patients and medical staff, you still couldn't find any positive benefits.'

Dr Tom Marshall, a senior lecturer in public health at the University of Birmingham, said: 'This does not mean that stopping smoking or changing diet are not effective. It means interventions to help people stop smoking or change their diet are not effective.'

He said the review indicated that changes in lifestyle for the average patient should be promoted through national policy changes.

Dr Satya Sharma, chair of Wolverhampton LMC, said: 'To get the best use of the money, people need to be able to see that advice from other sources, otherwise our beating the drum will not make a difference.'

• Multiple risk factor interventions were ineffective in achieving reductions in total or CVD mortality when used in general or workforce populations of middle-aged adults

• Despite small improvements in blood pressure and cholesterol, the benefits of interventions were very small compared with effects of statins and antihypertensives

• Health promotion through national policy and legislative changes should have a higher priority than primary prevention programmes aimed at low-risk patients

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