Abstract P127: Dose-dependent Effects of Comprehensive Lifestyle Changes on Blood Lipid Levels: Results From the PREMIER Trial

Abstract

Introduction: Low-density lipoprotein (LDLc) is a major risk factor for cardiovascular (CV) disease. While comprehensive lifestyle change (CLC) lowers LDLc, little is known about how CLC adherence affects LDLc levels. Hypothesis: The PREMIER trial demonstrated CLC reduced LDLc levels. We hypothesized those undergoing CLC will exhibit dose dependent reductions in LDLc proportional to the number of intervention sessions attended. Methods: PREMIER was a multicenter randomized trial in adults with pre-hypertension or stage 1 hypertension. The current analyses were limited to participants randomized to CLC interventions, excluding those who were assigned to control, those on lipid-lowering medication, or those missing follow-up lipid data. One intervention, “Established” (Est.), was a CLC that emphasized increased physical activity, weight reduction, reduced sodium intake, and a reduced fat/calorie diet. A second CLC intervention, “Established+DASH” (Est.+DASH), also included counseling on the DASH diet. Behavioral counseling was delivered via 18 sessions in the first 6 months and 15 sessions in the following 12 months (total 33 sessions). Results: Among the 450 participants, mean age was 50.4, 63% were women, and 31% were black. Baseline LDLc was 134 mg/dL in Est. and 134.8 mg/dL in Est.+DASH. Mean attendance in the first 6 months was 14.2 sessions in Est. and 14.6 in Est.+DASH, and in the last 12 months was 9.6 sessions in Est. and 10.1 sessions in Est.+DASH. There was no difference in attendance by intervention. After adjustment for factors associated with LDLc, every 10 CLC sessions were associated with a 6 mg/dL (P=0.003) lower LDLc ( Table ). This association was attenuated when adjusted for weight change. Similar patterns were noted for triglycerides and total cholesterol. Conclusions: Better attendance at CLC sessions was associated with larger reductions in LDLc over an 18 month period with evidence that weight loss mediated this relationship.