title: All-cause mortality of patients with dyslipidemia up to 19 years after a multidisciplinary lifestyle modification programme: a randomized trial.
abstract: BACKGROUND
  Many studies have shown that individual lifestyle factors are associated with cardiovascular mortality and all-cause mortality. Observational studies of comprehensive programmes have reported risk reductions. The objectives were to assess the long-term all-cause mortality by diagnosis in patients referred to a lifestyle modification programme, aimed at combating coronary heart disease and stroke.
  
  
  METHODS
  A randomized trial with 325 patients referred to the centre between 1988 and 1989 for dyslipidemia, hypertension, type 2 diabetes and coronary heart disease; 239 patients were randomized to the programme, 86 randomized to usual care. Cases were admitted to the centre in groups of 30 for a 4-week residential comprehensive activity, in total 114 full-time hours, focusing on food preferences and selections, and physical exercise. The activities were repeated during a 4-day revisit to the centre 1 year and 5 years after the 4-week intervention. Controls were referred back to their doctors, mainly in primary care, for usual care. Main outcome measure was all-cause mortality during 11–12 and 18–19 years after intervention.
  
  
  RESULTS
  At follow-up 11–12 years after referral, the relative risk reduction (RRR) was 76% with the intention-to-treat analysis among cases admitted for dyslipidemia (hazards ratio 0.24, confidence interval 0.06–0.89, P = 0.033). After 18–19 years, the RRR was 66% (hazards ratio 0.34, confidence interval 0.13–0.88, P = 0.026). No RRR was found for the other three diagnoses.
  
  
  CONCLUSIONS
  Patients admitted for dyslipidemia reached a real long-term RRR of all-cause mortality. They had by definition a need for this programme.
authors.affiliation: Department of Public Health and Clinical Medicine, Family Medicine, University of Umeå, Sweden.
authors.forename: Lena
authors.initials: L
authors.lastname: Håglin
authors.forename: Sara
authors.initials: S
authors.lastname: Lundström
authors.forename: Gunnar
authors.initials: G
authors.lastname: Kaati
authors.forename: Lennart
authors.initials: L
authors.lastname: Bäckman
authors.forename: Lars Olov
authors.initials: LO
authors.lastname: Bygren
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control*; D002423:Cause of Death; D016009:Chi-Square Distribution; D004032:Diet / Q000009:adverse effects; D050171:Dyslipidemias / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011314:Preventive Health Services; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome