title: Factors Influencing Physician Counseling on Cardiovascular Risk.
abstract: BACKGROUND
  A significant reduction in cardiovascular disease (CVD) mortality is related to aggressive management of modifiable CVD risk factors. Therefore, patients at increased risk for CVD should not only benefit from standard pharmacotherapy but also from counseling regarding lifestyle behavioral changes.
  
  
  OBJECTIVE
  To determine the patient factors that influence provision of cardiovascular risk reduction counseling from physicians, as well as the frequencies of counseling.
  
  
  METHODS
  Secondary analysis of a prospective, randomized trial among an underserved inner-city and rural population (n = 388) with a 10% or greater CVD risk (Framingham 10-year risk score). Subjects were followed for 1 year and were seen for quarterly assessments, which included evaluation of weight, blood pressure, lipid, and glucose status. At each of the 4 quarterly visits, subjects were asked if their physician had discussed or made recommendations regarding lifestyle behaviors, specifically diet, weight loss, and exercise.
  
  
  RESULTS
  The average patient age was 61.3 ± 10.1 years, average A1c was 6.7 ± 1.6%, average total cholesterol was 201 ± 44 mg/dL. The average body mass index (BMI) was 31.8 ± 6.4 kg/m2, and the average blood pressure was 146 ± 18/82 ±11 mm Hg. Using binary logistic regression analysis, BMI (P < .025) was the only clinical factor related to physician lifestyle counseling. All other risk factors showed no statistical relationship.
  
  
  CONCLUSIONS
  The data indicate that BMI is the major factor associated with whether or not physicians provide counseling regarding nutrition and weight loss. Physicians may be missing important opportunities to influence behavior in patients at high risk for CVD by limiting their focus to obese patients.
authors.affiliation: Temple University School of Medicine, Philadelphia, PA, USA vrakita@temple.edu.
authors.forename: Val
authors.initials: V
authors.lastname: Rakita
authors.affiliation: Temple University School of Medicine, Philadelphia, PA, USA.
authors.forename: Carol J
authors.initials: CJ
authors.lastname: Homko
authors.affiliation: Temple University School of Medicine, Philadelphia, PA, USA.
authors.forename: Abul
authors.initials: A
authors.lastname: Kashem
authors.affiliation: Temple University School of Medicine, Philadelphia, PA, USA.
authors.forename: Nabeel
authors.initials: N
authors.lastname: Memon
authors.affiliation: Temple University School of Medicine, Philadelphia, PA, USA.
authors.forename: Alfred A
authors.initials: AA
authors.lastname: Bove
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D002784:Cholesterol / Q000097:blood; D003376:Counseling / Q000706:statistics & numerical data*; D004032:Diet; D015444:Exercise; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000517:prevention & control; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D040242:Risk Reduction Behavior; D015431:Weight Loss
chemical_list: D002784:Cholesterol
keywords: disease management; health promotion; obesity; patient-centeredness; prevention