A combined lifestyle and medication intervention to reduce CHD risk

Background: Coronary heart disease (CHD) is the leading cause of death in the United States. As about half of U.S. adults are seen by primary care clinicians annually, effective prevention interventions offered in this setting have great potential for public health impact.

Methods: We developed two versions (web-based and counselor-based) of a combined lifestyle and medication intervention to reduce CHD risk and compared their effects in a randomized trial conducted at five socioeconomically diverse clinics in a practice-based research network. Both interventions are tailored to participants' baseline risk factors and treatment preferences and include similar content: a web-based decision aid, 4 monthly contacts during an intensive intervention phase (4 months) and 3 brief contacts at 2 month intervals during a maintenance phase (8 months). Major study outcomes were measured at 4 and 12 month follow-up, with the primary outcome the change in 10 year Framingham risk score at 4 month follow-up. Secondary outcomes include change in dietary intake, physical activity, blood pressure, blood lipids, and medication use. Acceptability, ease of implementation, and cost-effectiveness will also be assessed.

Results: Of 489 participants randomized to date, 263 have returned for the 4 month follow-up visit (93% of those who have reached this follow-up time point in the study). At this session, 4 month follow-up results including the primary study outcome will be reported for our full sample.

Conclusions: Understanding differences in outcomes between the two formats of this intervention will help inform successful implementation of high quality CHD prevention programs.