title: Which patient and treatment factors are related to successful cardiovascular risk score reduction in general practice? Results from a randomized controlled trial.
abstract: BACKGROUND
  Cardiovascular disease is a leading cause of death. It is important to identify patient and treatment factors that are related to successful cardiovascular risk reduction in general practice. This study investigates which patient and treatment factors are related to changes in cardiovascular risk estimation, expressed as the Systematic Coronary Risk Evaluation (SCORE) 10 year risk of cardiovascular mortality.
  
  
  METHODS
  179 general practice patients with mild-moderately elevated cardiovascular risk followed a one-year programme which included structured lifestyle and medication treatment by practice nurses, with or without additional self-monitoring. From the patient and treatment data collected as part of the "Self-monitoring and Prevention of RIsk factors by Nurse practitioners in the region of Groningen" randomized controlled trial (SPRING-RCT), the contribution of patient and treatment factors to the change in SCORE was analysed with univariate and multivariate analyses.
  
  
  RESULTS
  In multivariate analyses with multiple patient and treatment factors, only SCORE at baseline, and addition of or dose change in lipid lowering or antihypertensive medications over the course of the study were significantly related to change in SCORE.
  
  
  CONCLUSIONS
  Our analyses support the targeting of treatment at individuals with a high SCORE at presentation. Lipid lowering medication was added or changed in only 12% of participants, but nevertheless was significantly related to ΔSCORE in this study population. Due to the effect of medication in this practice-based project, the possible additional effect of the home monitoring devices, especially for individuals with no indication for medication, may have been overshadowed.
  
  
  BACKGROUND
  trialregister.nl NTR2188.
authors: University of Groningen, University Medical Center Groningen, Department General Practice, Groningen, The Netherlands. a.h.tiessen@umcg.nl
authors: Ans H
authors: AH
authors: Tiessen
authors: Andries J
authors: AJ
authors: Smit
authors: Jan
authors: J
authors: Broer
authors: Klaas H
authors: KH
authors: Groenier
authors: Klaas
authors: K
authors: Van der Meer
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality / Q000517:prevention & control / Q000628:therapy*; D015444:Exercise; D005260:Female; D006801:Humans; D006973:Hypertension; D008297:Male; D008875:Middle Aged; D050177:Overweight; D011320:Primary Health Care / Q000379:methods; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012648:Self Care / Q000379:methods; D012907:Smoking; D016896:Treatment Outcome
references: Cochrane Database Syst Rev. 2008 Apr 16;(2):CD000165
references: 18425860
references: Eur J Cardiovasc Prev Rehabil. 2010 Apr;17(2):244-9
references: 20195155
references: Eur J Cardiovasc Prev Rehabil. 2005 Oct;12(5):442-50
references: 16210930
references: Eur J Cardiovasc Prev Rehabil. 2005 Oct;12(5):433-41
references: 16210929
references: Eur J Cardiovasc Prev Rehabil. 2010 Oct;17(5):530-40
references: 20577089
references: Eur Heart J. 2003 Jun;24(11):987-1003
references: 12788299
references: BMC Public Health. 2013 Feb 18;13:148
references: 23418958
references: Eur J Cardiovasc Prev Rehabil. 2009 Jun;16(3):321-4
references: 19357519
references: Lancet. 2004 Sep 11-17;364(9438):953-62
references: 15364186
references: Diabet Med. 2012 Aug;29(8):e223-31
references: 22416789
references: Cochrane Database Syst Rev. 2011 Jan 19;(1):CD001561
references: 21249647
references: Int J Cardiol. 2010 Sep 3;143(3):385-90
references: 19386372
references: Eur J Cardiovasc Prev Rehabil. 2009 Apr;16(2):121-37
references: 19287307
references: JAMA. 2000 Jul 5;284(1):79-84
references: 10872017
references: Cochrane Database Syst Rev. 2013 Jan 31;(1):CD004816
references: 23440795
references: BMC Fam Pract. 2012 Sep 04;13:90
references: 22947269
references: Scand J Prim Health Care. 2010 Dec;28(4):242-8
references: 20873973
references: Cochrane Database Syst Rev. 2009 Jul 08;(3):CD001841
references: 19588327
references: Lancet. 2008 Jun 14;371(9629):1999-2012
references: 18555911
references: Scand J Prim Health Care. 2012 Jun;30(2):101-6
references: 22643155
references: Eur J Prev Cardiol. 2012 Aug;19(4):585-667
references: 22763626