Sustainability of a multiple risk factor intervention on cardiovascular disease in high-risk African American families.
OBJECTIVE
To determine the long-term effect of a community-based risk reduction intervention at five years after completion of a one-year randomized clinical trial and to determine the sustainability of the beneficial effects seen one year after the intervention.


METHODS
30- to 59- year-old African American siblings of probands with premature coronary heart disease (CHD) were randomized for care of multiple CHD risk factors to either one year of community-based care (CBC) provided by a nurse practitioner/community health worker team or enhanced usual care (EUC). At five years, 307 (84.6%) of the siblings returned for reevaluation.


METHODS
Changes in and achievement of goal levels of low-density lipoprotein cholesterol (LDL-C), systolic and diastolic blood pressure (SBP and DBP, respectively), and smoking cessation at five years.


RESULTS
No significant differences were seen between groups in mean LDL-C, SBP, and DBP or in the overall percentages achieving goal LDL-C, blood pressure, or smoking status. Changes after completion of the intervention suggest that the CBC group lost the beneficial effects for mean LDL-C and for percentage at goal LDL-C, while the EUC group continued to improve. CBC was associated with greater sustainability and less refractoriness of one-year results for LDL-C and blood pressure goals.


CONCLUSIONS
Although no group differences were found in mean risk factor levels at five years, data indicate that CBC is both feasible and associated with earlier sustainability of positive risk factor changes compared with EUC.
Division of General Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Crystal W
CW
Cene
Lisa R
LR
Yanek
Taryn F
TF
Moy
David M
DM
Levine
Lewis C
LC
Becker
Diane M
DM
Becker
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D015142:Baltimore / Q000453:epidemiology; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000097:blood / Q000517:prevention & control*; D008078:Cholesterol, LDL / Q000097:blood*; D003153:Community Health Services; D004198:Disease Susceptibility / Q000208:ethnology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D012307:Risk Factors; D035781:Siblings; D012907:Smoking / Q000453:epidemiology; D016540:Smoking Cessation / Q000706:statistics & numerical data*
D008078:Cholesterol, LDL