生活方式干预对血脂水平的剂量依赖性影响：PREMIER 试验的结果。
Dose-dependent effects of lifestyle interventions on blood lipid levels: Results from the PREMIER trial.
机构信息
Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Bloomberg School of Public Health, Baltimore, MD, USA; Department of Internal Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA.
Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD, USA; Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
出版信息
Patient Educ Couns. 2019 Oct;102(10):1882-1891. doi: 10.1016/j.pec.2019.05.005. Epub 2019 May 18.
OBJECTIVE
To assess the effects of comprehensive lifestyle modification on low-density lipoprotein cholesterol (LDL-C) levels and whether greater participation in counseling sessions was associated with greater LDL-C reductions.
METHODS
Multicenter trial of Pre- or Stage 1 hypertensive adults randomized to: (1)Advice alone, (2)'Established' lifestyle intervention implementing physical activity, sodium reduction, and weight loss, if overweight, or (3)'Established + DASH' lifestyle intervention with DASH diet counseling. Both intervention groups received behavioral counseling. We used generalized estimating equations to model the intervention's effects on lipid outcomes. Analyses of number of sessions and lipids were adjusted for demographics and medical history.
RESULTS
Among 756 participants (mean age 49.7, 63.2% women, 34.7% black), both lifestyle interventions reduced LDL-C, triglycerides, and total cholesterol (TC) at six months. Compared to the 'Advice' arm, net mean lipid changes in the Established group were: LDL-C of -5.6 mg/dL (p=0.001) and TC of -7.3 mg/dL (p<0.001). Similarly, changes in the 'Established + DASH' group were: LDL-C of -4.0 mg/dL (p=0.03) and TC of -5.7 mg/dL (p=0.006). In dose-response analyses, for every 10-session increase, LDL-C changed by -6.2 mg/dL (p=0.003).
CONCLUSIONS
Comprehensive lifestyle modification lowers LDL-C with greater benefit among persons who attend more counseling sessions.
PRACTICE IMPLICATIONS
Patient engagement is a critical aspect of effective lifestyle interventions.
目的
评估综合生活方式改变对低密度脂蛋白胆固醇（LDL-C）水平的影响，以及是否更多地参与咨询会议与更大的 LDL-C 降低有关。
方法
对患有前期或 1 期高血压的成年人进行多中心试验，随机分为：（1）仅提供建议，（2）实施身体活动、减少钠摄入和减轻体重（如果超重）的“既定”生活方式干预，或（3）增加 DASH 饮食咨询的“既定+DASH”生活方式干预。两个干预组均接受行为咨询。我们使用广义估计方程来模拟干预对血脂结果的影响。对参与者人数和血脂的分析根据人口统计学和病史进行了调整。
结果
在 756 名参与者中（平均年龄 49.7 岁，63.2%为女性，34.7%为黑人），两种生活方式干预均在 6 个月时降低了 LDL-C、甘油三酯和总胆固醇（TC）。与“建议”组相比，“既定”组的净平均血脂变化为：LDL-C 降低 5.6mg/dL（p=0.001）和 TC 降低 7.3mg/dL（p<0.001）。同样，“既定+DASH”组的变化为：LDL-C 降低 4.0mg/dL（p=0.03）和 TC 降低 5.7mg/dL（p=0.006）。在剂量反应分析中，每增加 10 次咨询，LDL-C 降低 6.2mg/dL（p=0.003）。
结论
综合生活方式改变可降低 LDL-C，而更多地参与咨询会议可带来更大的益处。
实践意义
患者的参与是生活方式干预有效的关键方面。
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