Effects of nutrition education on recurrent coronary events after percutaneous coronary intervention: A randomized clinical trial

Abstract

Changes in lifestyle include a healthy diet. However, due to different educational approaches, the effects of nutritional counselling are still not very encouraging and require further study. The objective of this study was to analyse the effectiveness of a nutrition education intervention program on mortality and recurrence of cardiovascular events evaluated after one and four years of follow-up. A randomized clinical trial was performed at a public hospital in Brazil with 200 patients who had recently undergone elective percutaneous coronary intervention (PCI). In addition to the traditional care, the patients allocated to the intervention group attended nutrition education workshops that adopted a constructivist approach towards behavioural change for six months. Primary outcome was death, and secondary outcomes were acute myocardial infarction (AMI), revascularization with re-PCI, or coronary artery bypass graft (CABG) surgery. The magnitude of the first year effect was calculated by the absolute risk reduction, and the risk ratio was calculated as a measure of the cumulative incidence of events after four years. The critical p-value was assumed as 5%. After one year of follow-up, in the intervention and control groups, respectively, there were 5 and 7 deaths (p = 0.53); 5 and 6 AMIs (p = 0.73); 4 and 6 re-PCIs (p = 0.50); and 4 and 4 CABGs (p = 0.98). After four years, the risk ratios between intervention and control groups were 0.75 (95% CI 0.35–1.58) for death, 0.89 (95% CI 0.34–2.28) for AMI, 0.86 (95% CI 0.40–1.84) for re-PCI, and 1.14 (95% CI 0.38–3.40) for CABG. Although differences in events between the two groups were not significant, data suggest that the lower number of events observed in the intervention group is most notable with the longer follow-up. NCT01028066 . Registered 8 December 2009, retrospectively registered.