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Effects of a community-based lifestyle intervention in older patients with coronary artery disease: results from the RESPONSE-2 trial

Session Poster Session 2

Speaker Patricia Jepma

Event : ESC Preventive Cardiology (Formerly EuroPrevent) 2019

  • Topic : preventive cardiology
  • Sub-topic : Secondary Prevention
  • Session type : Poster Session

Authors : P Jepma (Amsterdam,NL), HT Jorstad (Amsterdam,NL), RJG Peters (Amsterdam,NL), MS Snaterse (Amsterdam,NL), G Ter Riet (Amsterdam,NL), CHM Latour (Amsterdam,NL), M Minneboo (Amsterdam,NL), SM Boekholdt (Amsterdam,NL), WJM Scholte Op Reimer (Amsterdam,NL)

Authors:
P Jepma1 , HT Jorstad2 , RJG Peters2 , MS Snaterse1 , G Ter Riet3 , CHM Latour1 , M Minneboo2 , SM Boekholdt2 , WJM Scholte Op Reimer1 , 1Amsterdam University of Applied Sciences, ACHIEVE Centre for Applied Research, Faculty of Health - Amsterdam - Netherlands (The) , 2Amsterdam UMC, Department of Cardiology - Amsterdam - Netherlands (The) , 3Amsterdam UMC, Department of General Practice - Amsterdam - Netherlands (The) ,

On behalf: the RESPONSE2 group

Citation:

Background/Introduction: Interventions to reduce lifestyle-related risk factors (LRFs) such as overweight, physical inactivity and smoking are effective in the secondary prevention of cardiovascular events. However, evidence of the effects of lifestyle-related secondary prevention programmes in older patients is less conclusive than in younger patients.

Purpose: Using data of the RESPONSE-2 trial, we compared the treatment effect on LRFs in younger (< 65 years) patients to the effect in older (= 65 years) patients with coronary artery disease (CAD).

Methods: The RESPONSE-2 trial was a community-based lifestyle intervention trial (N=824) comparing nurse-coordinated referral to a comprehensive set of three lifestyle interventions (physical activity, weight reduction and/or smoking cessation) to care as usual. In the current analysis, our primary outcome was the proportion of patients with improvement at 12 months follow-up (N=711) in at least 1 LFR (without deterioration in the other LFRs) stratified by age.

Results: At baseline, patients = 65 years (n=145, mean age 69.2 ± 3.9) had significantly more risk factors and comorbidities (hypertension, diabetes mellitus and peripheral artery disease) compared with patients < 65 years (n=579, mean age 53.7 ± 3.9). At follow-up, the proportion of older patients with improvement in = 1 LFR was 41.4% (41/99) in the intervention group compared with 25.8% (31/120) patients in the control group (RR 1.60, 95% CI 1.09 - 2.35). The proportion of younger patients with improvement in = 1 LFR was 35.2% (92/261) in the intervention group compared with 26.0% (60/231) in the control group (RR 1.36, 95% CI 1.03 - 1.78) (figure). In the intervention group, older patients with baseline BMI = 27kg/m2 were more successful in achieving weight reduction (= 5%) compared with younger patients with baseline BMI = 27kg/m2  (52.8% vs. 25.4%, p <0.001).

Conclusion: Despite the presence of more risk factors and comorbidities, nurse-coordinated referral to a community-based lifestyle intervention appears to be at least as successful in improving lifestyle in older as in younger patients. Age alone should not be a reason to withhold comparable preventive initiatives in older adults with CAD.

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