title: Web-Based Interventions Targeting Cardiovascular Risk Factors in Middle-Aged and Older People: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Web-based interventions can improve single cardiovascular risk factors in adult populations. In view of global aging and the associated increasing burden of cardiovascular disease, older people form an important target population as well.
  
  
  OBJECTIVE
  In this systematic review and meta-analysis, we evaluated whether Web-based interventions for cardiovascular risk factor management reduce the risk of cardiovascular disease in older people.
  
  
  METHODS
  Embase, Medline, Cochrane and CINAHL were systematically searched from January 1995 to November 2014. Search terms included cardiovascular risk factors and diseases (specified), Web-based interventions (and synonyms) and randomized controlled trial. Two authors independently performed study selection, data-extraction and risk of bias assessment. In a meta-analysis, outcomes regarding treatment effects on cardiovascular risk factors (blood pressure, glycated hemoglobin A1c (HbA1C), low-density lipoprotein (LDL) cholesterol, smoking status, weight and physical inactivity) and incident cardiovascular disease were pooled with random effects models.
  
  
  RESULTS
  A total of 57 studies (N=19,862) fulfilled eligibility criteria and 47 studies contributed to the meta-analysis. A significant reduction in systolic blood pressure (mean difference -2.66 mmHg, 95% CI -3.81 to -1.52), diastolic blood pressure (mean difference -1.26 mmHg, 95% CI -1.92 to -0.60), HbA1c level (mean difference -0.13%, 95% CI -0.22 to -0.05), LDL cholesterol level (mean difference -2.18 mg/dL, 95% CI -3.96 to -0.41), weight (mean difference -1.34 kg, 95% CI -1.91 to -0.77), and an increase of physical activity (standardized mean difference 0.25, 95% CI 0.10-0.39) in the Web-based intervention group was found. The observed effects were more pronounced in studies with short (<12 months) follow-up and studies that combined the Internet application with human support (blended care). No difference in incident cardiovascular disease was found between groups (6 studies).
  
  
  CONCLUSIONS
  Web-based interventions have the potential to improve the cardiovascular risk profile of older people, but the effects are modest and decline with time. Currently, there is insufficient evidence for an effect on incident cardiovascular disease. A focus on long-term effects, clinical endpoints, and strategies to increase sustainability of treatment effects is recommended for future studies.
authors.affiliation: Academic Medical Center, Department of Neurology, University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Cathrien R L
authors.identifier: http://orcid.org/0000-0003-0199-0723
authors.initials: CR
authors.lastname: Beishuizen
authors.forename: Blossom C M
authors.identifier: http://orcid.org/0000-0002-1235-360X
authors.initials: BC
authors.lastname: Stephan
authors.forename: Willem A
authors.identifier: http://orcid.org/0000-0003-3174-8233
authors.initials: WA
authors.lastname: van Gool
authors.forename: Carol
authors.identifier: http://orcid.org/0000-0001-5307-663X
authors.initials: C
authors.lastname: Brayne
authors.forename: Ron J G
authors.identifier: http://orcid.org/0000-0002-3642-5022
authors.initials: RJ
authors.lastname: Peters
authors.forename: Sandrine
authors.identifier: http://orcid.org/0000-0002-1142-770X
authors.initials: S
authors.lastname: Andrieu
authors.forename: Miia
authors.identifier: http://orcid.org/0000-0003-0992-3875
authors.initials: M
authors.lastname: Kivipelto
authors.forename: Hilkka
authors.identifier: http://orcid.org/0000-0002-2785-9937
authors.initials: H
authors.lastname: Soininen
authors.forename: Wim B
authors.identifier: http://orcid.org/0000-0002-3393-9511
authors.initials: WB
authors.lastname: Busschers
authors.forename: Eric P
authors.identifier: http://orcid.org/0000-0002-1489-5218
authors.initials: EP
authors.lastname: Moll van Charante
authors.forename: Edo
authors.identifier: http://orcid.org/0000-0002-7250-3390
authors.initials: E
authors.lastname: Richard
mesh_terms: D000368:Aged; D001794:Blood Pressure; D001835:Body Weight; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000378:metabolism / Q000517:prevention & control*; D008078:Cholesterol, LDL / Q000378:metabolism; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D020407:Internet; D008875:Middle Aged; D009043:Motor Activity; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D040242:Risk Reduction Behavior; D057185:Sedentary Behavior; D012907:Smoking; D016540:Smoking Cessation; D013813:Therapy, Computer-Assisted / Q000379:methods*; D015431:Weight Loss
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin
keywords: aging; cardiovascular disease; eHealth; meta-analysis; older people; prevention; systematic review