title: Effectiveness of a preventive cardiology programme for high CVD risk persistent smokers: the EUROACTION PLUS varenicline trial.
abstract: OBJECTIVE
  The EUROACTION PLUS trial measured the effectiveness of a nurse-led preventive cardiology programme (EUROACTION) offering intensive smoking cessation PLUS optional varenicline for persistent high CVD risk smokers to reduce overall cardiovascular risk compared with usual care (UC) in general practice (GP).
  
  
  RESULTS
  A parallel group randomized controlled trial in 20 GP in Italy, Netherlands, Spain, and UK. Six hundred and ninety-six current smokers, (137 vascular disease and 559 high total CVD risk), were randomized 350 to EUROACTION PLUS (EA+) and 346 to UC. Specially, trained nurses offered the EUROACTION preventive cardiology programme addressing smoking cessation, diet, physical activity, and risk factor management to reduce overall cardiovascular risk. The primary endpoint was 7 day point prevalence of self-reported abstinence (validated breath carbon monoxide <10 p.p.m.) at 16 weeks. Secondary outcomes included dietary habits, physical activity, weight, blood pressure (BP), lipid, and glucose management. One hundred and seventy-seven (51%) EA+ patients (91% opted to use varenicline) were abstinent vs. 63 (19%) in UC; OR 4.52 (95% CI: 3.20-6.39). The Mediterranean diet score of ≥9 in 149 (52%) EA+ patients vs. 97 (37%) in UC; OR 1.84 (95% CI: 1.31-2.59). Physical activity target achieved in 46 (16%) EA+ patients vs. 19 (7%) in UC; OR 2.48 (95% CI: 1.41-4.36). Target BP (<140/90 mm Hg) achieved in 150 (52%) EA+ patients vs. 112 (43%) in UC, OR 1.47 (95% CI: 1.05-2.06) with no difference in antihypertensive drugs. There were no differences in management of cholesterol or glucose.
  
  
  CONCLUSIONS
  The EUROACTION preventive cardiology programme in high CVD risk smokers using optional varenicline substantially increased smoking abstinence over 16 weeks and also reduced overall cardiovascular risk compared with UC. REC reference: 09/H0402/85; EudraCT number: 2009-012451-18; http://www.controlled-trials.com/ISRCTN22073647, 12 February 2014, date last accessed.
authors.affiliation: Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London (St Mary's Campus), International Centre for Circulatory Health, London W2 1LA, UK d.wood2@imperial.ac.uk.
authors.forename: Catriona
authors.initials: C
authors.lastname: Jennings
authors.affiliation: Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London (St Mary's Campus), International Centre for Circulatory Health, London W2 1LA, UK.
authors.forename: Kornelia
authors.initials: K
authors.lastname: Kotseva
authors.affiliation: Unit of Epidemiology and Preventive Medicine, Department of Public Health, Ghent University, Gent 9000, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: De Bacquer
authors.affiliation: University Medical Center Utrecht, PO Box 85500, Utrecht 3508 GA, The Netherlands.
authors.forename: Arno
authors.initials: A
authors.lastname: Hoes
authors.affiliation: Servicio Cardiologie, Hospital General Universitario, Valencia, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: de Velasco
authors.affiliation: Department of Medical and Biological Sciences, University of Udine, AOUD S M Della Miserciordi Udine, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Brusaferro
authors.affiliation: Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London (St Mary's Campus), International Centre for Circulatory Health, London W2 1LA, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Mead
authors.affiliation: Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London (St Mary's Campus), International Centre for Circulatory Health, London W2 1LA, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Jones
authors.affiliation: Department of Preventive Cardiology, Oslo University Hospital, Ullevål, Oslo N-0407, Norway.
authors.forename: Serena
authors.initials: S
authors.lastname: Tonstad
authors.affiliation: Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London (St Mary's Campus), International Centre for Circulatory Health, London W2 1LA, UK.
authors.forename: David
authors.initials: D
authors.lastname: Wood
mesh_terms: D001552:Benzazepines / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000451:nursing / Q000517:prevention & control*; D004032:Diet; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018722:Nicotinic Agonists / Q000627:therapeutic use*; D011810:Quinoxalines / Q000627:therapeutic use*; D040242:Risk Reduction Behavior; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D016896:Treatment Outcome; D000068580:Varenicline
chemical_list: D001552:Benzazepines; D018722:Nicotinic Agonists; D011810:Quinoxalines; D000068580:Varenicline
keywords: High cardiovascular risk; Preventive cardiology; Smoking cessation