Abstract
The effectiveness of lifestyle interventions within secondary prevention of coronary heart disease (CHD) remains unclear. This systematic review aimed to determine their effectiveness and included randomized controlled trials of lifestyle interventions, in primary care or community settings, with a minimum follow-up of three months, published since 1990. 21 trials with 10,799 patients were included; the interventions were multifactorial (10), educational (4), psychological (3), dietary (1), organisational (2), and exercise (1). The overall results for modifiable risk factors suggested improvements in dietary and exercise outcomes but no overall effect on smoking outcomes. In trials that examined mortality and morbidity, significant benefits were reported for total mortality (in 4 of 6 trials; overall risk ratio (RR) 0.75 (95% confidence intervals (CI) 0.65, 0.87)), cardiovascular mortality (3 of 8 trials; overall RR 0.63 (95% CI 0.47, 0.84)), and nonfatal cardiac events (5 of 9 trials; overall RR 0.68 (95% CI 0.55, 0.84)). The heterogeneity between trials and generally poor quality of trials make any concrete conclusions difficult. However, the beneficial effects observed in this review are encouraging and should stimulate further research.
Highlights
The World Health Organisation has stated that, since 1990, more people worldwide have died from coronary heart disease (CHD) than any other cause [1]
We included male and female adults of all ages with a diagnosis of CHD. Patients included those who had experienced a myocardial infarction (MI), coronary artery bypass graft (CABG), or percutaneous transluminal coronary angioplasty (PTCA) and those with angina pectoris and coronary artery disease defined by angiography
We have excluded from this review studies which were not randomized controlled trials, focused on primary prevention, involved patients with multiple diseases and/or outcomes which were related to diseases other than CHD, involved patients in a hospital in-patient setting, focused on drug therapy, had short or no follow-up, or reported outcomes which were not the focus of this review such as depression, cost-effectiveness, or service delivery
Summary
The World Health Organisation has stated that, since 1990, more people worldwide have died from coronary heart disease (CHD) than any other cause [1]. Research has shown that lifestyle change, including PA, a healthy diet, and smoking cessation, alters the course of CHD [5,6,7], and so disease prevention measures have been designed to focus on a range of lifestyle factors. The guidelines covered secondary prevention in primary and secondary care and were not focused solely on lifestyle interventions. They did, incorporate PA, diet, smoking, and drug therapy and were based on systematic reviews of the best available evidence. To our knowledge no comprehensive systematic review has been undertaken since 2001 of the effects of diet, exercise, and other lifestyle factors in the secondary prevention of CHD.
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