A Randomized Community-Based Intervention to Reduce CVD Risk: The Heart Strategies Concentrating on Risk Evaluation (HeartSCORE) Study

Abstract

Sustained reductions in CVD risk factors among asymptomatic adults and are recruited from the community rather than clinical treatment settings are difficult to achieve PURPOSE: To assess the effectiveness of a randomized multidisciplinary intervention to reduce cardiovascular disease (CVD) risk factors in community-dwelling adults. METHODS: From the community-based Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) study, 468 adults (ages 45 to 75, mean 62; 43% female; 39% black) classified as intermediate/high Framingham risk were randomly assigned to a multidisciplinary risk reduction Intervention (INT:n=227) or Usual Care (UC:n=241) regimen, and had baseline and 1-year assessments of CVD risk factors. The INT consisted of 4 individually-tailored components: nutrition, physical activity, relaxation physiology, and smoking cessation administered over 6-months. RESULTS: Percentage decreases in animal/saturated fat intake, and percentage intake in monounsaturated fat, were greater in the INT group (P<0.05). Similarly, INT participants more often decreased body weight at 1 year by >5% (23% vs. 8%, p<0.001) and quit smoking (p=0.02). Both INT and UC participants achieved substantial (but similar) 1-year mean reductions in systolic blood pressure (-8.9 vs. -7.0 mmHg), diastolic blood pressure (-4.5 vs. -3.5 mmHg), LDL cholesterol (-8.0 vs. -9.7 mg/dl), and triglycerides (-20.7 versus -19.3 mg/dl). The INT group also showed significantly greater improvements in physical activity (males) and flexibility training (females). Conclusions: In community-based adults, an individualized multidisciplinary intervention can achieve sustained reductions in dietary fat intake, weight loss, blood pressure, lipids, and smoking cessation. Additionally, an informed usual care regimen can lead to clinically significant reductions in blood pressure and lipids. Supported by the Commonwealth of Pennsylvania.