Eight-year outcomes of a program for early prevention of cardiovascular events: a growth-curve analysis.
BACKGROUND
Early identification of cardiovascular diseases allows us to prevent the progression of these diseases. The Bale/Doneen Method, a prevention and treatment program for heart attacks and ischemic strokes, has been adopted nationally in primary care and specialty clinics.


OBJECTIVE
The main purpose of this study was to evaluate the effect of the Bale/Doneen Method on lipoproteins and carotid intima-media thickness (IMT) for cardiovascular disease prevention and reduction. A secondary purpose was to illustrate the use of latent growth-curve analysis in studying trajectories of clinical outcomes and biomarkers in individual patients over time.


METHODS
This retrospective analysis is based on 576 patients at a nurse-managed ambulatory clinic who received the heart attack prevention and treatment program from 2000 to 2008. All patients were white; 61% were men; mean age was 55.5 years. Outcome measures include hemoglobin A1c, fasting blood sugar, plaque burden score (PBS), high-density lipoprotein, low-density lipoprotein (LDL), mean carotid artery IMT, and lipoprotein-associated phospholipase A2 test results. Latent growth-curve analysis was used in modeling changes in these outcome measures.


RESULTS
On average, mean IMT score decreased by 0.01 per year (P < .001), PBS decreased by 0.17 per year (P < .001), LDL decreased by 5.19 per year (P < .001), and lipoprotein-associated phospholipase A2 decreased by 3.6 per year (P < .05). Hemoglobin A1c increased by 0.04 per year (P < .001). Significant sex and age differences in the initial level and/or rate of change of mean IMT, PBS, fasting blood sugar, high-density lipoprotein, and LDL scores were found.


CONCLUSIONS
The current findings suggest that the Bale/Doneen Method is effective in generating a positive effect on the atherosclerotic disease process by achieving regression of disease in the carotid arteries.
Du Feng, PhD Professor, School of Nursing, University of Nevada, Las Vegas. M. Christina Esperat, PhD, RN, FAAN Professor,School of Nursing, Texas Tech University Health Science Center, Lubbock. Amy L. Doneen, RN, BSN, MSN, ARNP Adjunct Professor, Texas Tech Health Science Center, School of Nursing, and Cofounder and Medical Director, the Heart Attack & Stroke Prevention Center, Spokane, Washington. Bradley Bale, MD Adjunct Professor, Texas Tech Health Science Center, School of Nursing, and Medical Director, the Heart Health Program for Grace Clinic, Lubbock, Texas. Huaxin Song, PhD Lead Analyst, School of Nursing, Texas Tech University Health Science Center, Lubbock. Alexia E. Green, PhD, RN, FAAN Professor,School of Nursing, Texas Tech University Health Science Center, Lubbock.
Du
D
Feng
M Christina
MC
Esperat
Amy L
AL
Doneen
Bradley
B
Bale
Huaxin
H
Song
Alexia E
AE
Green
D002318:Cardiovascular Diseases / Q000517:prevention & control*; D059168:Carotid Intima-Media Thickness; D005260:Female; D006801:Humans; D008074:Lipoproteins / Q000097:blood; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015397:Program Evaluation; D012189:Retrospective Studies; D013997:Time Factors
D008074:Lipoproteins