title: Randomized clinical trial to assess the efficacy of a comprehensive programme of secondary prevention of cardiovascular disease in general practice: the PREseAP study.
abstract: OBJECTIVE
  To assess the efficacy of a comprehensive program of secondary prevention of cardiovascular disease in general practice.
  
  
  METHODS
  A cluster randomized clinical trial was carried out in a regular general practice setting. Male and female patients aged under 86 years with a diagnosis of ischemic heart disease, stroke or peripheral artery disease were recruited between January 2004 and May 2005. Study participants were seen at 42 health centers throughout the whole of Spain. The primary endpoint was the combination of all-cause mortality and hospital cardiovascular readmission at 3-year follow-up.
  
  
  RESULTS
  In total, 1224 patients were recruited: 624 in the intervention group and 600 in the control group. The primary endpoint was observed in 29.9% (95% confidence interval [CI], 25.5-34.8%) in the intervention group and 25.6% (22.3-29.2%) in the control group (P=.15). At the end of follow-up, 8.5% (6.3-11.3%) in the intervention group and 11% (7.4-16%) in the control group were smokers (P=.07). The mean waist circumference of patients in the intervention and control groups was 100.44 cm (95% CI, 98.97-101.91 cm) and 102.58 cm (95% CI, 100.96-104.21 cm), respectively (P=.07). Overall, 20.9% (15.6-27.7%) of patients in the intervention group and 29.6% (23.9-36.1%) in the control group suffered from anxiety (P=.05), and 29.6% (22.4-37.9%) in the intervention group and 41.4% (35.8-47.3%) in the control group had depression (P=.02).
  
  
  CONCLUSIONS
  A comprehensive program of secondary prevention of cardiovascular disease in general practice was not effective in reducing cardiovascular morbidity and mortality. However, some factors associated with a healthy lifestyle were improved and anxiety and depression were reduced.
authors.affiliation: Unidad de Investigación, Equipo de Atención Primaria Sardenya-IIB Sant Pau, Barcelona, Spain. cbrotons@eapsardenya.cat
authors.forename: Carlos
authors.initials: C
authors.lastname: Brotons
authors.forename: Núria
authors.initials: N
authors.lastname: Soriano
authors.forename: Irene
authors.initials: I
authors.lastname: Moral
authors.forename: María P
authors.initials: MP
authors.lastname: Rodrigo
authors.forename: Pilar
authors.initials: P
authors.lastname: Kloppe
authors.forename: Ana I
authors.initials: AI
authors.lastname: Rodríguez
authors.forename: María L
authors.initials: ML
authors.lastname: González
authors.forename: Dolores
authors.initials: D
authors.lastname: Ariño
authors.forename: Domingo
authors.initials: D
authors.lastname: Orozco
authors.forename: Francisco
authors.initials: F
authors.lastname: Buitrago
authors.forename: Josep M
authors.initials: JM
authors.lastname: Pepió
authors.forename: Isabel
authors.initials: I
authors.lastname: Borrás
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D005260:Female; D058006:General Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D055502:Secondary Prevention