title: Effect of screening and lifestyle counselling on incidence of ischaemic heart disease in general population: Inter99 randomised trial.
abstract: OBJECTIVE
  To investigate the effect of systematic screening for risk factors for ischaemic heart disease followed by repeated lifestyle counselling on the 10 year development of ischaemic heart disease at a population level.
  
  
  METHODS
  Randomised controlled community based trial.
  
  
  METHODS
  Suburbs of Copenhagen, Denmark.
  
  
  METHODS
  59,616 people aged 30-60 years randomised with different age and sex randomisation ratios to an intervention group (n = 11,629) and a control group (n = 47,987).
  
  
  METHODS
  The intervention group was invited for screening, risk assessment, and lifestyle counselling up to four times over a five year period. All participants with an unhealthy lifestyle had individually tailored lifestyle counselling at all visits (at baseline and after one and three years); those at high risk of ischaemic heart disease, according to predefined criteria, were furthermore offered six sessions of group based lifestyle counselling on smoking cessation, diet, and physical activity. After five years all were invited for a final counselling session. Participants were referred to their general practitioner for medical treatment, if relevant. The control group was not invited for screening.
  
  
  METHODS
  The primary outcome measure was incidence of ischaemic heart disease in the intervention group compared with the control group. Secondary outcome measures were stroke, combined events (ischaemic heart disease, stroke, or both), and mortality.
  
  
  RESULTS
  6091 (52.4%) people in the intervention group participated at baseline. Among 5978 people eligible at five year follow-up (59 died and 54 emigrated), 4028 (67.4%) attended. A total of 3163 people died in the 10 year follow-up period. Among 58,308 without a history of ischaemic heart disease at baseline, 2782 developed ischaemic heart disease. Among 58,940 without a history of stroke at baseline, 1726 developed stroke. No significant difference was seen between the intervention and control groups in the primary end point (hazard ratio for ischaemic heart disease 1.03, 95% confidence interval 0.94 to 1.13) or in the secondary endpoints (stroke 0.98, 0.87 to 1.11; combined endpoint 1.01, 0.93 to 1.09; total mortality 1.00, 0.91 to 1.09).
  
  
  CONCLUSIONS
  A community based, individually tailored intervention programme with screening for risk of ischaemic heart disease and repeated lifestyle intervention over five years had no effect on ischaemic heart disease, stroke, or mortality at the population level after 10 years.Trial registration Clinical trials NCT00289237.
authors.affiliation: Research Centre for Prevention and Health, Building 84/85, Glostrup Hospital, DK-2600 Glostrup, Denmark Faculty of Health Science, University of Copenhagen, Denmark Faculty of Medicine, University of Aalborg, Denmark torben.joergensen@regionh.dk.
authors.forename: Torben
authors.initials: T
authors.lastname: Jørgensen
authors.affiliation: Research Centre for Prevention and Health, Building 84/85, Glostrup Hospital, DK-2600 Glostrup, Denmark.
authors.forename: Rikke Kart
authors.initials: RK
authors.lastname: Jacobsen
authors.affiliation: Research Centre for Prevention and Health, Building 84/85, Glostrup Hospital, DK-2600 Glostrup, Denmark.
authors.forename: Ulla
authors.initials: U
authors.lastname: Toft
authors.affiliation: Research Centre for Prevention and Health, Building 84/85, Glostrup Hospital, DK-2600 Glostrup, Denmark.
authors.forename: Mette
authors.initials: M
authors.lastname: Aadahl
authors.affiliation: Research Centre for Prevention and Health, Building 84/85, Glostrup Hospital, DK-2600 Glostrup, Denmark Faculty of Medicine, University of Aalborg, Denmark.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Glümer
authors.affiliation: Research Centre for Prevention and Health, Building 84/85, Glostrup Hospital, DK-2600 Glostrup, Denmark Faculty of Health Science, University of Copenhagen, Denmark.
authors.forename: Charlotta
authors.initials: C
authors.lastname: Pisinger
mesh_terms: D000328:Adult; D037001:Directive Counseling; D005260:Female; D006801:Humans; D015994:Incidence; D008019:Life Style; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology* / Q000517:prevention & control*