Effectiveness of multidisciplinary patient counselling in reducing cardiovascular disease risk factors through nonpharmacological intervention: results from the Healthy Heart Program.

摘要

BACKGROUND: The value of lifestyle modification in reducing physiological cardiovascular disease (CVD) risk factors remains controversial because changes in patient behaviour following CVD prevention counseling have failed to correlate with or impact reductions in physiological variables. OBJECTIVES: To determine whether nonpharmacological CVD prevention counselling significantly reduces behavioural and physiological risk factors, and to examine correlations between changes in these variables. METHODS: At baseline, dyslipidemic individuals with or at risk of developing CVD completed CVD risk factor questionnaires. At baseline and three months, participants submitted dietary logs, self-classified their readiness for behaviour change for eight lifestyles, and had their blood lipid profiles, weight and height assessed. Following CVD risk factor screening, lower and higher risk participants were recommended for multidisciplinary group counselling (GC) or group plus individual counselling (GIC), respectively. A prospective time series design assessed behavioural and physiological risk factor changes. RESULTS: Participants progressed forward (P<0.01) through the stage of change continuum for all behaviours. GIC participants progressed to a higher average stage of behaviour change for achieving optimal body weight (P<0.01), drinking less alcohol (P<0.05) and controlling blood pressure (P<0.05). Significant reductions in body mass index (2.1% and 1.9%), total cholesterol (7.0% and 5.5%), low density lipoprotein cholesterol (6.2% and 5.4%), total cholesterol to high density lipoprotein cholesterol ratio (5.1% and 3.8%) and triglyceride levels (10.8% and 8.5%) were observed in GC and GIC participants, respectively. Furthermore, significant correlations were observed between concurrent changes in lifestyle behaviour and physiological risk factors. CONCLUSIONS: Multidisciplinary CVD prevention counseling positively influenced participant readiness for lifestyle behaviour change which translated into significant reductions in several physiological risk factors.