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Experts urge ‘more intensive’ lifestyle change programmes for patients at risk of CVD

Intensive lifestyle interventions in high-risk patients can lower cardiovascular mortality by up to a fifth, conclude UK researchers.

The systematic review of five trials looked at data from more than 31,000 patients who were free of CVD at baseline, but were identified as at high risk by a validated risk score.

The authors looked at the affect of various lifestyle interventions in these patients and found the effect on CVD mortality ranged from 7.4% over six months to a 22% reduction over five years.

They found those who had undergone the most intensive interventions experienced the greatest reductions in CVD risk and mortality.

The authors cited the MRFIT trial as an example of a more intensive intervention, where patients had two initial screening sessions and then 10 weekly group sessions and annual assessments to discuss how to manage their risk factors.

They concluded that a more ‘aggressive' approach was needed in primary care to manage patients identified as at high risk of CVD.

The researchers concluded: ‘The findings of this review highlight the importance of targeting individuals at higher risk of CVD who have the most to gain in terms of absolute reduction in CVD risk and where the best evidence for improvement is shown.'

Study author Professor Kamlesh Khunti, professor of primary care diabetes and vascular medicine at the University of Leicester and a GP in the city, said: ‘Patients have the risk score assessments, but don't implement all the changes that are needed.

‘I think what GPs and nurses can do is actively do the risk score assessments and then aggressively manage the risk factors.'

Professor Khunti told Pulse that the NHS had been successful in its smoking cessation drive, but there was a lack of lifestyle interventions available to patients.

He added there was a ‘fantastic opportunity' with the NHS Health Checks programme, as it requires the calculation of a validated risk score to identify those at risk of CVD and that the patient is provided with appropriate management including lifestyle interventions and pharmacological therapy.

J R Soc Med 2012:105;348-56


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