Impact of a community-based multiple risk factor intervention on cardiovascular risk in black families with a history of premature coronary disease.
BACKGROUND
Black subjects with a family history of premature coronary heart disease (CHD) have a marked excess risk, yet barriers prevent effective risk reduction. We tested a community-based multiple risk factor intervention (community-based care [CBC]) and compared it with "enhanced" primary care (EPC) to reduce CHD risk in high-risk black families.


RESULTS
Black 30- to 59-year-old siblings of a proband with CHD aged <60 years were randomized for care of BP > or =140/90 mm Hg, LDL cholesterol > or =3.37 mmol/L, or current smoking to EPC (n=168) or CBC (n=196) and monitored for 1 year. EPC and CBC were designed to eliminate barriers to care. The CBC group received care by a nurse practitioner and a community health worker in a community setting. The CBC group was 2 times more likely to achieve goal levels of LDL cholesterol and blood pressure compared with the EPC group (95% CI, 1.11 to 4.20 and 1.39 to 3.88, respectively) with adjustment for baseline levels of age, sex, education, and baseline use of medications. The CBC group demonstrated a significant reduction in global CHD risk, whereas no reduction was seen in the EPC group (P<0.0001).


CONCLUSIONS
Eliminating known barriers may not be sufficient to reduce CHD risk in primary care settings. An alternative community care model that addresses barriers may be a more effective way to ameliorate CHD risk in high-risk black families.
Becker
Diane M
DM
Division of General Internal Medicine, Johns Hopkins Medical Institutions, 1830 E Monument St, Room 8028, Baltimore, MD 21287, USA. dbecker@jhmi.edu
Yanek
Lisa R
LR
Johnson
Wallace R
WR
Garrett
Diane
D
Moy
Taryn F
TF
Reynolds
Stasia Stott
SS
Blumenthal
Roger S
RS
Vaidya
Dhananjay
D
Becker
Lewis C
LC
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015142:Baltimore / Q000453:epidemiology; D008078:Cholesterol, LDL / Q000097:blood; D003144:Communication Barriers; D003152:Community Health Nursing; D003153:Community Health Services; D003150:Community Health Workers; D003159:Community-Institutional Relations; D003327:Coronary Disease / Q000208:ethnology / Q000235:genetics / Q000451:nursing / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000208:ethnology; D004032:Diet; D004198:Disease Susceptibility; D015444:Exercise; D005192:Family Health; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000175:diagnosis / Q000208:ethnology; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D011320:Primary Health Care / Q000379:methods*; D012306:Risk; D035781:Siblings; D012907:Smoking / Q000453:epidemiology / Q000208:ethnology; D016540:Smoking Cessation; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D008078:Cholesterol, LDL