Multiple lifestyle changes in people with established coronary heart disease reduce the risk for cardiovascular events

de Waure C, Lauret GJ, Ricciardi W, et al. Lifestyle interventions in patients with coronary heart disease: A systematic review. American Journal of Preventive Medicine. 2013. Volume 45, Issue 2, pages 207-216.

Review question

How effective are interventions with multiple lifestyle components (such as diet AND exercise) in reducing the risk for cardiovascular events in patients with established heart disease?

Background

Heart disease is associated with a higher risk of cardiovascular events[DK1] , including myocardial infarction (heart attack), stroke, and death from heart disease. These events can be fatal (causing death) or non-fatal. Secondary prevention of heart disease involves interventions to prevent the worsening of the disease, or to prevent acute cardiovascular events, in people who already have heart disease.

Interventions generally attempt to change at least two behaviors that increase risk for heart disease, including diet, exercise, smoking and psychological factors.

How the review was done

This summary is based on a high-quality review of 14 randomized controlled trials conducted between 1979 and 2011 with 6,657 participants.

Study participants, most of whom were men, ranged in 53 to 80 years old. The average age was 60.

All of the interventions included nutritional recommendations as well as physical activity instruction. 11 studies also included smoking recommendations and half provided interventions around stress management.

The intervention group was compared with a group receiving usual care, which was defined as a treatment chosen by their doctor.

The interventions varied in length from 29 days to 6 years, but most were 2 or 3 years long. Studies followed participants for periods from 1 to 19 years following the intervention.

What the researchers found

Multi-component interventions reduce the risk of fatal cardiovascular events by 18% in patients with established heart disease when compared with usual care. These interventions had no impact on non-fatal or total cardiovascular events.

Conclusion

Multicomponent lifestyle interventions are effective in preventing fatal cardiovascular events in patients with established heart disease.