Abstract 16435: Lifestyle Interventions Reduce Ten-Year Risk of Atherosclerotic Cardiovascular Disease as Predicted by the Pooled Cohort Equations

Abstract

Introduction: Lifestyle measures, such as adoption of the DASH diet, weight reduction, and exercise, are effective in lowering blood pressure. The degree to which these behaviors reduce the risk of cardiovascular events is not well-established. We examined the effect of dietary and weight management inventions used in the ENCORE study on the 10-year risk of atherosclerotic cardiovascular disease (ASCVD), as defined by the Pooled Cohort Equations. Methods: Participants included 129 overweight or obese men and women between the ages of 40 and 80 years who had blood pressure 130-160/80-99 mmHg and who were not treated with antihypertensive medications. Subjects were randomized to 16 weeks of DASH diet plus behavioral weight management (consisting of nutritional counseling and a behavioral weight management program)(DASH+WM), DASH diet alone (consisting of nutritional counseling without exercise or caloric restriction)(DASH), or usual care (UC). Results: The participants averaged 53.5±8.8 years of age; 68% were female, and 60% were white. One had diabetes and 11 (9%) were smokers. Systolic BP averaged 138±9 mmHg; total and HDL cholesterol averaged 203±36 mg/dl and 55±14 mg/dl, respectively. The average estimated 10-year risk of ASCVD for the entire cohort was 5.7%. The baseline characteristics of the subjects randomized to DASH+WM (n=46), DASH (n=39), and UC (n=44) were similar. Participants in the DASH+WM and DASH interventions had significant decreases in systolic blood pressure, and those in the DASH+WM group had a significant decrease in total cholesterol. Post-intervention estimated 10-year ASCVD risk [mean(SE)], adjusted for baseline values, was 4.4(0.2)% for DASH+WM, 5.0(0.3)% for DASH, and 5.7(0.2)% for UC (p<.001 for DASH+WM vs UC; p<.05 for DASH vs UC). The number of untreated subjects with an indication for consideration of statin therapy, as recommended in the 2013 ACC/AHA Guideline for the Treatment of Blood Cholesterol, fell from 11 to 6 in DASH+WM and from 12 to 10 in DASH, while remaining unchanged (11) in UC. Conclusions: In overweight or obese men and women with high BP, lifestyle interventions reduce the predicted 10-year risk of ASCVD and decrease the number of individuals in whom statin therapy is recommended.