Efficacy of multifactorial lifestyle interventions in patients with established cardiovascular diseases and high risk groups.
BACKGROUND
Lifestyle modification is recommended for patients with established cardiovascular diseases (CVD) or at high risk of CVD. In recent years, risk factor interventions in which multiple risk factors are addressed simultaneously are increasingly conducted.


OBJECTIVE
To determine, and if possible quantify, the efficacy of multifactorial lifestyle interventions (without drug therapy) in patients with established CVD or in high risk groups.


METHODS
A literature search was conducted using 'Pubmed', to identify articles of randomized controlled trials (RCTs) or reviews of RCTs, published between 1990 and 2007.


RESULTS
In patients with established CVD, multifactorial lifestyle interventions can reduce the occurrence of cardiovascular diseases and/or mortality, even many years after the end of the intervention. Further, in both patients and high risk groups, multifactorial lifestyle interventions have favorable effects on biological risk factors and lifestyle and are able to reduce the incidence of diabetes. In the long-term, in particular lifestyle changes seem to persist, such as improved dietary habits and increased physical activity, while the favorable effects on biological risk factors, such as body weight and blood pressure, are no longer different from the control group. Regular contact with the participants seems to be part of the "success factor".


CONCLUSIONS
It can be recommended to offer patients with established CVD as well as individuals at high risk of CVD a comprehensive lifestyle advice, as part of their medical treatment, combined with intensive counseling.
National Institute for Public Health and the Environment, Centre for Prevention and Health Services Research, Bilthoven, The Netherlands. anneke.blokstra@rivm.nl
Anneke
A
Blokstra
Ineke
I
van Dis
Wm Monique
WM
Verschuren
D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000451:nursing / Q000517:prevention & control; D003376:Counseling / Q000592:standards* / Q000706:statistics & numerical data; D006293:Health Promotion / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008019:Life Style; D012307:Risk Factors; D040242:Risk Reduction Behavior