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.