title: Statin prescription initiation and lifestyle behaviour: a primary care cohort study.
abstract: Statin prescribing and healthy lifestyles contribute to declining cardiovascular disease mortality. Recent guidelines emphasise the importance of giving lifestyle advice in association with prescribing statins but adherence to healthy lifestyle recommendations is sub-optimal. However, little is known about any change in patients' lifestyle behaviours when starting statins or of their recall of receiving advice. This study aimed to examine patients' diet and physical activity (PA) behaviours and their recall of lifestyle advice following initiation of statin prescribing in primary care.
  
  
  
  In 12 general practices, patients with a recent initial prescription of statin therapy, were invited to participate. Those who agreed received a food diary by post, to record food consumed over 4 consecutive days and return to the researcher. We also telephoned participants to administer brief validated questionnaires to assess typical daily diet (DINE) and PA level (Godin). Using the same methods, food diaries and questionnaires were repeated 3 months later. At both times participants were asked if they had changed their behaviour or received advice about their diet or PA.
  
  
  
  Of 384 invited, 122 (32 %) participated; 109 (89.3 %) completed paired datasets; 50 (45.9 %) were male; their mean age was 64 years. 53.2 % (58/109) recalled receiving lifestyle advice. Of those who did, 69.0 % (40/58) reported having changed their diet or PA, compared to 31.4 % (16/51) of those who did not recall receiving advice. Initial mean daily saturated fat intake (12.9 % (SD3.5) of total energy) was higher than recommended; mean fibre intake (13.8 g/day (SD5.5)), fruit/vegetable consumption (2.7 portions/day (SD1.3)) and PA levels (Godin score 7.1 (SD13.9)) were low. Overall, although some individuals showed evidence of behaviour change, there were no significant changes in the proportions who reported high or medium fat intake (42.2 % v 49.5 %), low fibre (51.4 % v 55.0 %), or insufficient PA (80.7 % v 83.5 %) at 3-month follow-up.
  
  
  
  Whilst approximately half of our cohort recalled receiving lifestyle advice associated with statin prescribing this did not translate into significant changes in diet or PA. Further research is needed to explore gaps between people's knowledge and behaviours and determine how best to provide advice that supports behaviour change.
authors.affiliation: Centre for Public Health, Institute of Clinical Sciences Block B, Royal Victoria Hospital, Queen's University Belfast, Grosvenor Road, Belfast, BT12 6BA, UK.
authors.forename: S F
authors.initials: SF
authors.lastname: McAleer
authors.affiliation: Centre for Public Health, Institute of Clinical Sciences Block B, Royal Victoria Hospital, Queen's University Belfast, Grosvenor Road, Belfast, BT12 6BA, UK. m.cupples@qub.ac.uk.|UKCRC Centre of Excellence for Public Health Research (NI), Institute of Clinical Sciences Block B, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK. m.cupples@qub.ac.uk.|Department of General Practice and Primary Care, Queen's University, Belfast, UK. m.cupples@qub.ac.uk.
authors.forename: M E
authors.initials: ME
authors.lastname: Cupples
authors.affiliation: Centre for Public Health, Institute of Clinical Sciences Block B, Royal Victoria Hospital, Queen's University Belfast, Grosvenor Road, Belfast, BT12 6BA, UK.
authors.forename: C E
authors.initials: CE
authors.lastname: Neville
authors.affiliation: Centre for Public Health, Institute of Clinical Sciences Block B, Royal Victoria Hospital, Queen's University Belfast, Grosvenor Road, Belfast, BT12 6BA, UK.|UKCRC Centre of Excellence for Public Health Research (NI), Institute of Clinical Sciences Block B, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK.
authors.forename: M C
authors.initials: MC
authors.lastname: McKinley
authors.affiliation: Centre for Public Health, Institute of Clinical Sciences Block B, Royal Victoria Hospital, Queen's University Belfast, Grosvenor Road, Belfast, BT12 6BA, UK.|UKCRC Centre of Excellence for Public Health Research (NI), Institute of Clinical Sciences Block B, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK.
authors.forename: J V
authors.initials: JV
authors.lastname: Woodside
authors.affiliation: Centre for Public Health, Institute of Clinical Sciences Block B, Royal Victoria Hospital, Queen's University Belfast, Grosvenor Road, Belfast, BT12 6BA, UK.|UKCRC Centre of Excellence for Public Health Research (NI), Institute of Clinical Sciences Block B, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK.|Department of General Practice and Primary Care, Queen's University, Belfast, UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Tully
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004032:Diet; D015930:Diet Records; D004041:Dietary Fats / Q000008:administration & dosage; D004043:Dietary Fiber / Q000008:administration & dosage; D037001:Directive Counseling; D011307:Drug Prescriptions; D015444:Exercise; D005260:Female; D005638:Fruit; D015438:Health Behavior; D000070497:Healthy Lifestyle; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D011795:Surveys and Questionnaires; D014675:Vegetables
chemical_list: D004041:Dietary Fats; D004043:Dietary Fiber; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Behaviour change; Cardiovascular disease; Cohort study; Diet; Lifestyle; Patient education; Physical activity; Primary care; Statin prescribing