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RESPONSE-2: Community-based lifestyle intervention benefits patients with CAD
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A nurse-coordinated referral to a set of community-based lifestyle interventions conferred improved lifestyle-related risk factors in patients with CAD, researchers reported.
The RESPONSE-2 trial included 824 patients from 15 institutions in the Netherlands who were hospitalized less than 8 weeks for ACS and/or coronary revascularization and who had at least one of the following lifestyle-related risk factors: BMI of at least 27 kg/m2, self-reported physical inactivity or self-reported smoking less than 6 months before admission.
The patients were randomly assigned to the usual care or the usual care plus nurse-coordinated referral to between one and three interventions: Weight Watchers for those with BMI of at least 27 kg/m2, Philips DirectLife for those with physical inactivity and Luchtsignaal for smokers.
The primary outcome was proportion of success at 12 months, defined as a reduction of at least 5% in weight for those with BMI of at least 27 kg/m2, an improvement of at least 10% in 6-minute walk distance for those with physical activity and smoking cessation as detected by urinary cotinine for smokers.
At 12 months, data were available for 711 patients. Among those, 37% of the intervention group were successful, compared with 26% in the control group (RR = 1.43; 95% CI, 1.14-1.78).
Patients in the intervention group were also stratified by whether they had partner participation, defined as a partner attending at least one visit to a lifestyle program. Among those in the intervention group, those with partner participation had a 46% success rate vs. 34% for those without it (P = .03).
The number needed to treat to achieve lifestyle-related risk factor improvement in one patient was 10, Madelon Minneboo, MD, from the department of cardiology at Academic Medical Center in Amsterdam, and colleagues wrote.
The results were driven by success in weight reduction, and “it is unclear if the referrals for smoking cessation and physical activity were synergistic as suggested by the authors or if a similar benefit would have been seen with Weight Watchers therapy alone,” David J. Maron, MD, and Alexander T. Sandhu, MD, MS, both from the division of cardiovascular medicine, department of medicine, Stanford University School of Medicine, wrote in a related editorial.
“Given physicians’ limited success in modifying patient behavior, it is time to look outside of the clinic for assistance,” Maron and Sandhu wrote. “Evidence-based, commercial programs may help patients improve lifestyle risk factors and prevent [CV] events.” – by Erik Swain
Disclosure s : The study was sponsored by Philips Consumer Lifestyle, Weight Watchers and an anonymous private fund. Two authors report financial ties with Amgen, AstraZeneca, Boehringer Ingelheim, Pfizer and Sanofi. Maron and Sandhu report no relevant financial disclosures.
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