Eugenia Gianos1, Antoinette Schoenthaler2, Yu Guo2, Judy Zhong2, Howard Weintraub3, Arthur Schwartzbard3, James Underberg3, Michael Schloss3, Jonathan D Newman3, Sean Heffron4, Edward A Fisher4, Jeffrey S Berger4. 1. Department of Medicine, Division of Cardiology, Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, New York, NY. Electronic address: Eugenia.Gianos@nyumc.org. 2. Department of Population Health, Center for Healthful Behavioral Change, New York University School of Medicine, New York, NY. 3. Department of Medicine, Division of Cardiology, Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, New York, NY. 4. Department of Medicine, Division of Cardiology, Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, New York, NY; Marc and Ruti Bell Program in Vascular Biology, New York University School of Medicine, New York, NY.
Abstract
BACKGROUND:Patients undergoing cardiovascular (CV) procedures often have suboptimal CV risk factor control and may benefit from strategies targeting healthy lifestyle behaviors and education. Implementation of prevention strategies may be particularly effective at this point of heightened motivation. METHODS: A prospective, randomized, pilot study was conducted in 400 patients undergoing anonurgent CV procedure (cardiac catheterization ± revascularization) to evaluate the impact of different prevention strategies. Patients were randomized in a 1:1:1 fashion to usual care (UC; group A, n = 134), in-hospital CV prevention consult (PC; group B, n = 130), or PC plus behavioral intervention program (telephone-based motivational interviewing and optional tailored text messages) (group C, n = 133). The primary end point was the Δ change in non-high-density lipoprotein cholesterol (non-HDL-C) from baseline to 6 month. RESULTS:The mean age was 64.6 ± 10.8 years, 23.7% were female, and 31.5% were nonwhite. After 6 months, the absolute difference in non-HDL-C for all participants was -19.8 mg/dL (95% CI -24.1 to -15.6, P < .001). There were no between-group differences in the primary end point for the combined PC groups (B and C) versus UC, with a Δ adjusted between group difference of -5.5 mg/dL (95% CI -13.1 to 2.1, P = .16). Patients in the PC groups were more likely to be on high-intensity statins at 6 months (52.9% vs 38.1%, P = .01). After excluding participants with baseline non-HDL-C <100 mg/dL (initial exclusion criterion), Δ non-HDL-C and Δ low-density lipoprotein cholesterol were improved in the PC groups compared to UC (non-HDL-C -8.13 mg/dL [-16.00 to -0.27], P = .04; low-density lipoprotein cholesterol -7.87mg/dL [-15.10 to -0.64], P = .03). CONCLUSIONS: Although non-HDL-C reduction at 6 months following a nonurgent CV procedure was not significant in the overall cohort, an increased uptake in high-potency statins may translate into improved long-term health outcomes and cost reductions.
RCT Entities:
BACKGROUND:Patients undergoing cardiovascular (CV) procedures often have suboptimal CV risk factor control and may benefit from strategies targeting healthy lifestyle behaviors and education. Implementation of prevention strategies may be particularly effective at this point of heightened motivation. METHODS: A prospective, randomized, pilot study was conducted in 400 patients undergoing a nonurgent CV procedure (cardiac catheterization ± revascularization) to evaluate the impact of different prevention strategies. Patients were randomized in a 1:1:1 fashion to usual care (UC; group A, n = 134), in-hospital CV prevention consult (PC; group B, n = 130), or PC plus behavioral intervention program (telephone-based motivational interviewing and optional tailored text messages) (group C, n = 133). The primary end point was the Δ change in non-high-density lipoprotein cholesterol (non-HDL-C) from baseline to 6 month. RESULTS: The mean age was 64.6 ± 10.8 years, 23.7% were female, and 31.5% were nonwhite. After 6 months, the absolute difference in non-HDL-C for all participants was -19.8 mg/dL (95% CI -24.1 to -15.6, P < .001). There were no between-group differences in the primary end point for the combined PC groups (B and C) versus UC, with a Δ adjusted between group difference of -5.5 mg/dL (95% CI -13.1 to 2.1, P = .16). Patients in the PC groups were more likely to be on high-intensity statins at 6 months (52.9% vs 38.1%, P = .01). After excluding participants with baseline non-HDL-C <100 mg/dL (initial exclusion criterion), Δ non-HDL-C and Δ low-density lipoprotein cholesterol were improved in the PC groups compared to UC (non-HDL-C -8.13 mg/dL [-16.00 to -0.27], P = .04; low-density lipoprotein cholesterol -7.87mg/dL [-15.10 to -0.64], P = .03). CONCLUSIONS: Although non-HDL-C reduction at 6 months following a nonurgent CV procedure was not significant in the overall cohort, an increased uptake in high-potency statins may translate into improved long-term health outcomes and cost reductions.
Authors: Yehuda Handelsman; Jeffrey I Mechanick; Lawrence Blonde; George Grunberger; Zachary T Bloomgarden; George A Bray; Samuel Dagogo-Jack; Jaime A Davidson; Daniel Einhorn; Om Ganda; Alan J Garber; Irl B Hirsch; Edward S Horton; Faramarz Ismail-Beigi; Paul S Jellinger; Kenneth L Jones; Lois Jovanovič; Harold Lebovitz; Philip Levy; Etie S Moghissi; Eric A Orzeck; Aaron I Vinik; Kathleen L Wyne Journal: Endocr Pract Date: 2011 Mar-Apr Impact factor: 3.443
Authors: Clara K Chow; Julie Redfern; Graham S Hillis; Jay Thakkar; Karla Santo; Maree L Hackett; Stephen Jan; Nicholas Graves; Laura de Keizer; Tony Barry; Severine Bompoint; Sandrine Stepien; Robyn Whittaker; Anthony Rodgers; Aravinda Thiagalingam Journal: JAMA Date: 2015 Sep 22-29 Impact factor: 56.272
Authors: S Matthijs Boekholdt; Benoit J Arsenault; Samia Mora; Terje R Pedersen; John C LaRosa; Paul J Nestel; R John Simes; Paul Durrington; Graham A Hitman; K M A Welch; David A DeMicco; Aeilko H Zwinderman; Michael B Clearfield; John R Downs; Andrew M Tonkin; Helen M Colhoun; Antonio M Gotto; Paul M Ridker; John J P Kastelein Journal: JAMA Date: 2012-03-28 Impact factor: 56.272
Authors: William B Borden; Rita F Redberg; Alvin I Mushlin; David Dai; Lisa A Kaltenbach; John A Spertus Journal: JAMA Date: 2011-05-11 Impact factor: 56.272
Authors: Dean G Karalis; Raghunandan Dudda Subramanya; Scott E Hessen; Longjian Liu; Mark F Victor Journal: Am J Cardiol Date: 2011-01-19 Impact factor: 2.778
Authors: Eugenia Gianos; Antoinette Schoenthaler; Michael Mushailov; Edward A Fisher; Jeffrey S Berger Journal: Am Heart J Date: 2015-06-06 Impact factor: 4.749
Authors: Lisa Tully; Eugenia Gianos; Anish Vani; Yu Guo; Revathi Balakrishnan; Arthur Schwartzbard; James Slater; Richard Stein; James Underberg; Howard Weintraub; Edward Fisher; Jeffrey S Berger Journal: Am Heart J Date: 2014-06-02 Impact factor: 4.749
Authors: Lori Mosca; Heidi Mochari; Ming Liao; Allison H Christian; Dana J Edelman; Brooke Aggarwal; Mehmet C Oz Journal: Circ Cardiovasc Qual Outcomes Date: 2008-11-12
Authors: Calvin Ngai; Lisa Ganguzza; Laura Flink; Kathleen Woolf; Yu Guo; Victor Acosta; Eugenia Gianos; James Slater; Joseph Burdowski; Binita Shah Journal: Am J Cardiol Date: 2018-12-18 Impact factor: 2.778