title: Four-year follow-up of the Choice of Health Options In prevention of Cardiovascular Events randomized controlled trial.
abstract: OBJECTIVE
  To determine if the improved risk factor profile at 1 year attributed to the Choice of Health Options In prevention of Cardiovascular Events (CHOICE) program was maintained at 4 years.
  
  
  METHODS
  Single-blind randomized controlled trial with post-hoc 476 months follow-up (76% complete).
  
  
  METHODS
  Australian tertiary referral hospital.
  
  
  METHODS
  Two hundred and eight acute coronary syndrome survivors.
  
  
  METHODS
  Acute coronary syndrome survivors not accessing cardiac rehabilitation (CR) were randomized to control (n=72) or CHOICE (n=72) comprising the tailored risk factor reduction packaged as a clinic visit and 3 months phone support. A contemporary CR reference group were also recruited (n=64). Blinded risk assessment occurred at baseline, 1 and 4 years.
  
  
  METHODS
  Total cholesterol, systolic blood pressure, smoking status, physical activity.
  
  
  RESULTS
  One year improvements in all the modifiable risk factors achieved in CHOICE were maintained at 4 years. CHOICE and control were well-matched at baseline. At 4 years, there was a trend towards lower total cholesterol in CHOICE compared with controls (mean 4.0±0.1 vs. 4.2±0.1 mmol/l, P=0.05), significantly better systolic blood pressure (mean 132.2±2.1 vs. 136.8±2.0 mmHg, P=0.01), physical activity scores (1200±209 vs. 968±196 metabolic equivalent min/week, P=0.02) and proportion with three or more risk factors above national targets (20 vs. 42%,P=0.02). Participants in CHOICE were at higher baseline risk than CR but at 4 years they had similar risk factor profiles.
  
  
  CONCLUSIONS
  Participants in CHOICE maintained favorable changes in coronary risk profile at 4 years compared with control, indicating that CHOICE is an effective long-term intervention among those not accessing facility-based CR.
authors.affiliation: Faculty of Medicine, University of Sydney, Sydney, Australia. lneubeck@med.usyd.edu.au
authors.forename: Lis
authors.initials: L
authors.lastname: Neubeck
authors.forename: S B
authors.initials: SB
authors.lastname: Freedman
authors.forename: Tom
authors.initials: T
authors.lastname: Briffa
authors.forename: Adrian
authors.initials: A
authors.lastname: Bauman
authors.forename: Julie
authors.initials: J
authors.lastname: Redfern
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D015992:Body Mass Index; D019090:Case Management; D016009:Chi-Square Distribution; D002784:Cholesterol / Q000097:blood; D015444:Exercise; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D009517:New South Wales; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D016037:Single-Blind Method; D016540:Smoking Cessation; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol