Lifestyle Intervention Targets Families of CVD Patients

NEW ORLEANS — Hospitalization for a cardiovascular event may create a unique educational opportunity to induce members of the patient's immediate family to adopt heart-healthy lifestyle changes.

This notion was tested in a study of about 500 family members who were randomized to either a special, educational intervention or to more conventional primary-prevention care, and while the study failed to produce a significantly better outcome for its primary end point, the results showed some signs that the strategy has a future.

The special intervention, lifestyle-change program “was associated with significantly greater dietary improvement and a beneficial effect on change in high-density lipoprotein cholesterol compared with the control intervention,” Dr. Lori Mosca said at the annual scientific sessions of the American Heart Association.

The results also showed that many close relatives of patients hospitalized for cardiovascular disease (CVD) were unaware of their own risk for a similar event. “We need to build into our guidelines recommendations to screen and educate relatives,” said Dr. Mosca, professor of medicine at Columbia University and director of preventive cardiology at New York-Presbyterian Hospital in New York.

“We showed systematically that there was a 'teachable moment' when a family member was hospitalized. We should take advantage of that,” as well as similar moments that may come up when a patient with CVD is seen in a physician's office, she said in an interview. A lifestyle intervention program for families members similar to the one tested in this study has been in place at New York-Presbyterian for nearly 8 years. The educational materials used in the program are available for free in both English and Spanish at the Web site for Dr. Mosca's program, www.hearthealthtimes.com

“These data support the use of teachable moments,” similar to successful programs already in place to get myocardial infarction patients to stop smoking and improve other risk factors, commented Dr. C. Noel Bairey Merz, who is director of the women's heart center and the preventive and rehabilitative cardiac center at Cedars-Sinai Medical Center in Los Angeles.

The Family-Intervention Trial to Improve Heart Health (FIT-Heart) study recruited family members of patients hospitalized for CVD at New York-Presbyterian. Recruitment was done among family members visiting patients' rooms, in family waiting rooms, and by invitations included in the admission packets given to patients during January 2005-June 2006. Among 3,649 adult family members approached, 501 agreed to participate and gave informed consent. Only one person per family was included in the study group, but other family members were welcome to also attend the intervention visits.

Randomization assigned 250 people to the special intervention group; they underwent a diet and laboratory assessment and received personalized risk-factor education and lifestyle-change counseling from a master's-level health educator. Reinforcement phone calls were made to these people at 2 and 6 weeks after the intervention started, and they were seen at clinic visits at 3, 6, and 9 months. The other 251 people were assigned to a control intervention group and underwent a similar baseline assessment but received only a general heart-healthy message. A letter was also sent to the health care providers of people in this group if they had a critical risk-factor level. The study's primary end point was the average change in serum level of LDL cholesterol 1 year after the intervention started; 1-year follow-up data were available for 232 people in each study arm.

The average LDL cholesterol level fell by virtually the same amount in both study arms: 4.4% in the special intervention group and 4.5% in the control group. The two groups also had similar improvements in their amount of exercise each week. However, both groups also showed significant and similar increases in the average levels of blood pressure and waist size. The results were published simultaneously with Dr. Mosca's report at the meeting (Circ. Cardiovasc. Qual. Outcomes 2008;1:98–106).

But the special intervention group had significantly more improvement than did the control subjects in their diet, and serum levels of HDL cholesterol were unchanged in the special intervention group but significantly fell in the control group with an average reduction of about 3%.

Dr. Mosca said she was hopeful that the “improvements in lifestyle associated with the special intervention may have beneficial effects that go far beyond what we measure in practice.”

In addition, “as we go forward, lifestyle interventions need to address a more comprehensive approach to controlling blood pressure and, most importantly, adiposity and weight,” Dr. Mosca said. “We need to move to a more Mediterranean-style diet.”

'We showed systematically that there was a “teachable moment” when a family member was hospitalized.' DR. MOSCA