Cardiovascular Disease, Coronary Heart Disease
Conditions
Keywords
Diet interventions, Physical activity interventions, Medication adherence, Tailored interventions
Brief summary
Cardiovascular disease (CVD), including heart disease and stroke, is the leading cause of death in the US. Every year, more than one million Americans have a heart attack, and nearly 800,000 have a stroke. In 2010, heart disease alone is expected to cost the country more than $316 billion in health care and lost productivity. Both lifestyle changes and medication can reduce the risk of CVD, and this project combines these approaches in the hopes of identifying a practical intervention for use in primary care medical offices. The project combines two previously tested interventions and updates them to meet current guidelines for diet and use of aspirin and cholesterol-controlling drugs (statins). The research team is delivering the combined intervention in two formats: web-based and counselor-based. Each format has the same content, but the web-based advice is accessed through the Internet by clients at home, a community site, or a primary care office. The other format involves sessions delivered to clients by a counselor either in person at a primary care office or over the telephone. The researchers will compare how effective each format is in reducing participants' risk of coronary heart disease. They will also determine the interventions' effect on participants' diet, physical activity, smoking status, medication adherence, and other health indicators. In addition, the team will compare the two formats' cost-effectiveness and how well the patients, office staff, and clinicians accept the interventions. Recruited from five family practices, 600 patients representing the geographic and ethnic diversity of North Carolina are taking part in this study. Half the participants are randomly assigned to the web-based intervention; the other half to the counselor-based version. Both groups will also get information on local resources, such as gyms and farmers markets, that can help participants maintain a healthy lifestyle.
Interventions
BEHAVIORALLifestyle and medication intervention
The Heart to Health Intervention combines and enhances two previously tested interventions to reduce CVD risk (a counselor-based intervention to improve lifestyle and a web-based intervention to improve medication adherence). The new lifestyle and medication adherence intervention (delivered alternately in a one-on-one counseling or web-format) includes a decision aid on heart disease risk and risk-reducing options, general education on lifestyle and medication adherence, tips for overcoming barriers to CHD risk reduction, and goal setting and specification of first steps.
Sponsors
Centers for Disease Control and Prevention
University of North Carolina, Chapel Hill
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
35 Years to 79 Years
Healthy volunteers
Yes
Inclusion criteria
* Established patients * Men ages 35-79 * Women ages 45-79 * History of CVD (100 participants) * CHD risk equal or greater than 10% * elevated CHD risk factor
Exclusion criteria
* non-English speaking * no phone * treatment of psychosis * history of alcohol/substance abuse within last 2 years * pregnancy, breast feeding, or anticipated pregnancy in next 18 months * history of malignancy, other than non-melanoma skin cancer, that has not been in remission or cured surgically for \>5 years * recent history (in past year) of hypoglycemic event requiring medical attention * estimated creatinine clearance less than 30 ml/min
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Predicted 10-year CHD risk | 4-month follow-up | Framingham risk scores are well-validated and provide an absolute estimate of the likelihood of CHD events (MI, angina, and CHD death) over a 10-year time period. We will examine absolute changes in this outcome in both intervention arms. We will also examine whether this outcome varies by subgroups of the following variables: baseline level of predicted CHD risk, age, race, SES, insurance status, overall health status, numeracy, literacy, # medications, # of perceived barriers to adherence, use of the intervention, time with the intervention, study practice site, and health counselor |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Predicted 10-year CHD risk | 12 months | Framingham risk scores are well-validated and provide an absolute estimate of the likelihood of CHD events (MI, angina, and CHD death) over a 10-year time period. |
| Use of and adherence to cardiovascular medicines | 4 and 12 months | Use of cardiovascular medicines will be by self-report. Adherence to cardiovascular medicines will be measured by the 8-Item Morisky scale and a single-item specifying overall percentage adherence to cardiovascular medicines(categorical). Participants will additionally report use of and adherence to individual medicines, including aspirin, blood pressure medicine, and cholesterol medicine. Aspirin adherence will be validated by serum thromboxane b2 in a subsample of participants. Blood pressure and cholesterol medicine use will be confirmed by changes in blood pressure and cholesterol. |
| Dietary Intake | 4 and 12 months | Dietary intake will be measured through a combination of self-report and objective measures. Participants will self-report diet on two validated questionnaires: the block questionnaire (fruit and vegetable intake) and the fat quality screener. Fruit and vegetable intake will be objectively measured by serum carotenoids. Fat quality will be objectively measured using RBC membrane fatty acids. |
| Physical activity | 4 and 12 months | Physical activity will be measured through a combination of self-report and objective measures. Participants will report physical activity on the validated modified RESIDE questionnaire. They will additionally wear a pedometer to monitor their daily total and aerobic steps. |
| Smoking status | 4 and 12 months | Smoking will be measured through a combination of self-report and urinary cotinine (Nicalert test strips). |
| Total, HDL, and direct LDL cholesterol | 4 and 12 months | Total, HDL, and direct LDL cholesterol will be measured via enzymatic calorametric testing. |
| Adverse events | 4 and 12 months | We will monitor the following adverse events: ED visits (self-report), hospitalizations (self-report), deaths (family report confirmed by death registry), GI bleeds (self-report), hemorrhagic stroke (self-report), musculoskeletal injury (self-report), renal dysfunction (serum creatinine), and liver dysfunction (AST). |
| Acceptability of the Intervention | 4 and 12 months | We will measure the acceptability of the intervention using process measures querying participants, office staff, and clinicians about the perceptions of the acceptability of the intervention and the time to deliver it. |
| Cost-effectiveness | 4 and 12 months | We will measure the cost-unit CHD risk reduction for the two interventions using a societal perspective. |
| Blood pressure | 4 and 12 months | Blood pressure will be measure via standardized protocol using an oscillometric automatic monitor |
Countries
United States
Outcome results
None listed