Dalhousie University, Halifax, Nova Scotia, Canada.
Can J Cardiol. 2013 Nov;29(11):1400-7. doi: 10.1016/j.cjca.2013.03.007. Epub 2013 Jun 21.
Primary care is well positioned to facilitate cardiovascular risk improvement and reduce future cardiovascular disease (CVD) burden.
The efficacy of risk factor screening, behavioural counselling, and pharmacological treatment to lower CVD risk was assessed via a prospective pre- and postintervention health risk assessment, individualized intervention with behaviour modification, risk factor treatment, and linkage to community programs, with 1-year follow-up and final health risk assessment. Primary outcome was the proportion of subjects with moderate and high baseline Framingham Risk Score (FRS) reducing their risk by 10% and 25%, respectively; the secondary end point was the proportion dropping ≥ 1 risk category.
Patients were enrolled (N = 1509) from March 2006 through October 2008 and 72% completed the study. This analysis focuses on 563 subjects with moderate or high baseline FRS, and excluded 325 low-risk patients and 205 with established CVD or diabetes mellitus. Median age was 56 years, 57.7% were female. The primary outcome was achieved in 31.8% (N = 112; 95% confidence interval [CI], 26.9%-36.6%) of moderate risk FRS participants and 47.9% (N = 101; 95% CI, 41.2%-54.6%) of high-risk participants. The secondary outcome was achieved by 37.2% (N = 210; 95% CI, 33.2%-41.2%). Prevalence of metabolic syndrome fell from 79.2% (N = 446; 95% CI, 75.9%-82.6%) at entry to 52.8% (N = 303; 95% CI, 48.7%-56.9%) at study end. Significant improvements in all modifiable risk factors occurred through lifestyle modification.
Global cardiovascular risk can be effectively decreased via lifestyle changes informed by readiness to change assessment and individualized counselling targeting specific behaviours.
ClinicalTrials.gov number NCT01620996.
初级保健在促进心血管风险改善和降低未来心血管疾病（CVD）负担方面具有得天独厚的优势。
通过前瞻性的干预前后健康风险评估、个体化的行为改变干预、危险因素治疗以及与社区项目的联系，评估了危险因素筛查、行为咨询和药物治疗降低 CVD 风险的效果，为期 1 年的随访和最终健康风险评估。主要结局是中等和高基线 Framingham 风险评分（FRS）患者分别降低 10%和 25%风险的比例；次要终点是降低≥1个风险类别的比例。
患者于 2006 年 3 月至 2008 年 10 月入选，72%的患者完成了研究。本分析重点关注基线 FRS 为中度或高度的 563 例患者，排除了 325 例低危患者和 205 例已确诊 CVD 或糖尿病患者。中位年龄为 56 岁，57.7%为女性。主要结局在 31.8%（N=112；95%置信区间[CI]，26.9%-36.6%）中度风险 FRS 患者和 47.9%（N=101；95%CI，41.2%-54.6%）高度风险患者中达到。次要结局在 37.2%（N=210；95%CI，33.2%-41.2%）的患者中达到。进入研究时，代谢综合征的患病率从 79.2%（N=446；95%CI，75.9%-82.6%）降至研究结束时的 52.8%（N=303；95%CI，48.7%-56.9%）。通过生活方式的改变，所有可改变的危险因素都显著改善。
通过基于改变准备评估的生活方式改变和针对特定行为的个体化咨询，可以有效地降低全球心血管风险。
ClinicalTrials.gov 编号 NCT01620996。
