Emma F van Bussel1, Marieke P Hoevenaar-Blom2, Wim B Busschers3, Edo Richard4, Ron J G Peters5, Willem A van Gool2, Eric P Moll van Charante3. 1. Department of General Practice, Academic Medical Center Amsterdam, Amsterdam, the Netherlands. Electronic address: e.f.vanbussel@amc.uva.nl. 2. Department of Neurology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands. 3. Department of General Practice, Academic Medical Center Amsterdam, Amsterdam, the Netherlands. 4. Department of Neurology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands; Department of Neurology, Donders Centre for Brain, Behaviour and Cognition, Radboud University Medical Center, Nijmegen, the Netherlands. 5. Department of Cardiology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands.
Abstract
INTRODUCTION:Primary cardiovascular prevention through simultaneously targeting multiple risk factors may be even more effective than single risk factor modification in older adults. The effects of multicomponent cardiovascular prevention on cardiovascular risk are explored. STUDY DESIGN: Post hoc analysis of the cluster randomized Prevention of Dementia by Intensive Vascular care trial. SETTING/PARTICIPANTS: Community-dwelling older adults aged 70-78 years, free from cardiovascular disease at baseline (n=2,254, 63.9% of the Prevention of Dementia by Intensive Vascular care trial population). INTERVENTION: Between 2006 and 2015, the intervention group received nurse-led vascular care every 4 months at the general practitioner practice, the control group received care as usual. MAIN OUTCOME MEASURES: Cardiovascular disease events and Systematic COronary Risk Evaluation in Older People (SCORE-OP), an index based on six risk factors for cardiovascular mortality. Effects were adjusted for clustering and assessed using mixed effects Cox proportional-hazard models and linear mixed models respectively. RESULTS: There was no effect of the intervention on cardiovascular disease events (hazard ratio=0.99, 95% CI=0.71, 1.38). During a median follow-up of 6.1 years, SCORE-OP increased from 14.0% and 13.9% to 23.9% and 25.0% in the intervention and control group, respectively (adjusted mean difference in increment in SCORE-OP between the study groups 0.60%, 95% CI= -0.01, 1.20). Exploratory analyses showed a larger reduction of 2.4 mmHg (95% CI=0.9, 3.9) in systolic blood pressure and 1.9% (95% CI=0.4, 3.4) in current cigarette smoking in the intervention group compared with the control group. CONCLUSIONS:Multicomponent cardiovascular prevention did not improve the overall risk profile in older adults in a primary prevention setting, relative to usual care. However, exploratory analyses showed an effect on blood pressure and smoking cessation. Possibly, contrast between study groups was too small because of the Hawthorne (being part of a study) effect and increasing quality of (preventive) health care for older adults, to yield an effect on the risk profile.
RCT Entities:
INTRODUCTION: Primary cardiovascular prevention through simultaneously targeting multiple risk factors may be even more effective than single risk factor modification in older adults. The effects of multicomponent cardiovascular prevention on cardiovascular risk are explored. STUDY DESIGN: Post hoc analysis of the cluster randomized Prevention of Dementia by Intensive Vascular care trial. SETTING/PARTICIPANTS: Community-dwelling older adults aged 70-78 years, free from cardiovascular disease at baseline (n=2,254, 63.9% of the Prevention of Dementia by Intensive Vascular care trial population). INTERVENTION: Between 2006 and 2015, the intervention group received nurse-led vascular care every 4 months at the general practitioner practice, the control group received care as usual. MAIN OUTCOME MEASURES: Cardiovascular disease events and Systematic COronary Risk Evaluation in Older People (SCORE-OP), an index based on six risk factors for cardiovascular mortality. Effects were adjusted for clustering and assessed using mixed effects Cox proportional-hazard models and linear mixed models respectively. RESULTS: There was no effect of the intervention on cardiovascular disease events (hazard ratio=0.99, 95% CI=0.71, 1.38). During a median follow-up of 6.1 years, SCORE-OP increased from 14.0% and 13.9% to 23.9% and 25.0% in the intervention and control group, respectively (adjusted mean difference in increment in SCORE-OP between the study groups 0.60%, 95% CI= -0.01, 1.20). Exploratory analyses showed a larger reduction of 2.4 mmHg (95% CI=0.9, 3.9) in systolic blood pressure and 1.9% (95% CI=0.4, 3.4) in current cigarette smoking in the intervention group compared with the control group. CONCLUSIONS: Multicomponent cardiovascular prevention did not improve the overall risk profile in older adults in a primary prevention setting, relative to usual care. However, exploratory analyses showed an effect on blood pressure and smoking cessation. Possibly, contrast between study groups was too small because of the Hawthorne (being part of a study) effect and increasing quality of (preventive) health care for older adults, to yield an effect on the risk profile.
Authors: Emma F van Bussel; Edo Richard; Wim B Busschers; Ewout W Steyerberg; Willem A van Gool; Eric P Moll van Charante; Marieke P Hoevenaar-Blom Journal: J Clin Hypertens (Greenwich) Date: 2019-07-11 Impact factor: 3.738