title: Reduced Cardiovascular Disease Incidence With a National Lifestyle Change Program.
abstract: BACKGROUND
  Lifestyle change programs implemented within healthcare systems could reach many Americans, but their impact on cardiovascular disease (CVD) remains unclear. The MOVE! program is the largest lifestyle change program implemented in a healthcare setting in the U.S. This study aimed to determine whether MOVE! participation was associated with reduced CVD incidence.
  
  
  METHODS
  This retrospective cohort study, analyzed in 2013-2015, used national Veterans Health Administration databases to identify MOVE! participants and eligible non-participants for comparison (2005-2012). Patients eligible for MOVE!-obese or overweight with a weight-related health condition, and no baseline CVD-were examined (N=1,463,003). Of these, 169,248 (12%) were MOVE!
  
  
  METHODS
  Patients were 92% male, 76% white, with mean age 52 years and BMI of 32. The main outcome was incidence of CVD (ICD-9 and procedure codes for coronary artery disease, cerebrovascular disease, peripheral vascular disease, and heart failure).
  
  
  RESULTS
  Adjusting for age, race, sex, BMI, statin use, and baseline comorbidities, over a mean 4.9 years of follow-up, MOVE! participation was associated with lower incidence of total CVD (hazard ratio [HR]=0.83, 95% CI=0.80, 0.86); coronary artery disease (HR=0.81, 95% CI=0.77, 0.86); cerebrovascular disease (HR=0.87, 95% CI=0.82, 0.92); peripheral vascular disease (HR=0.89, 95% CI=0.83, 0.94); and heart failure (HR=0.78, 95% CI=0.74, 0.83). The association between MOVE! participation and CVD incidence remained significant when examined across categories of race/ethnicity, BMI, diabetes, hypertension, smoking status, and statin use.
  
  
  CONCLUSIONS
  Although participation was limited, MOVE! was associated with reduced CVD incidence in a nationwide healthcare setting.
authors.affiliation: Atlanta VA Medical Center, Decatur, Georgia; Nutrition and Health Sciences, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, Georgia. Electronic address: sandrajackson@alum.emory.edu.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Jackson
authors.affiliation: Atlanta VA Medical Center, Decatur, Georgia; Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Sandra
authors.initials: S
authors.lastname: Safo
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Staimez
authors.affiliation: Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Qi
authors.initials: Q
authors.lastname: Long
authors.affiliation: Atlanta VA Medical Center, Decatur, Georgia; Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Mary K
authors.initials: MK
authors.lastname: Rhee
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Solveig A
authors.initials: SA
authors.lastname: Cunningham
authors.affiliation: Atlanta VA Medical Center, Decatur, Georgia; Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Darin E
authors.initials: DE
authors.lastname: Olson
authors.affiliation: Atlanta VA Medical Center, Decatur, Georgia; Division of General Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Tomolo
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Usha
authors.initials: U
authors.lastname: Ramakrishnan
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: K M Venkat
authors.initials: KMV
authors.lastname: Narayan
authors.affiliation: Atlanta VA Medical Center, Decatur, Georgia; Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Phillips
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D008019:Life Style; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D058014:Veterans Health; D061217:Weight Reduction Programs / Q000706:statistics & numerical data*