Elsevier

Preventive Medicine

Volume 132, March 2020, 105984
Preventive Medicine

Effectiveness of a stepwise cardiometabolic disease prevention program: Results of a randomized controlled trial in primary care

https://doi.org/10.1016/j.ypmed.2020.105984Get rights and content
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Highlights

  • It is known that screening for CVD risk factors in the general population does not reduce CVD related morbidity and mortality.

  • Targeted case finding of high-risk individuals might be an effective preventive strategy.

  • Implementation of stepwise CMD prevention in primary care improves detection of CMD and treatment of high-risk individuals.

  • Modelling to long-term endpoints as morbidity and mortality will have to confirm its (cost)-effectiveness.

Abstract

Effective preventive strategies for cardiometabolic disease (CMD) are needed. We aim to establish the effectiveness of a stepwise CMD risk assessment followed by individualized treatment if indicated compared to care as usual. We conducted a RCT between 2014 and 2017. Individuals (45–70 years) without CMD or CMD risk factors were invited for stepwise CMD risk assessment through a risk score (step1), additional risk assessment at the practice in case of high-risk (step2) and individualized follow-up treatment if indicated (step3). We compared newly detected CMD and newly prescribed drugs during one-year follow-up, and change in CMD risk profile between baseline and one-year follow-up among participants who completed step2 to matched controls. A CMD was diagnosed almost three times more often (OR 2.90, 95% CI 2.25: 3.72) in the intervention compared to the control group, in parallel with newly prescribed antihypertensive and lipid lowering drugs (OR 2.85, 95% CI 1.96: 4.15 and 3.23, 95% CI 2.03: 5.14 respectively). Waist circumference significantly decreased between the intervention compared to the control group (mean −3.08 cm, 95% CI −3.73: −2.43). No differences were observed for changes in BMI and smoking. Systolic blood pressure (mean −2.26 mmHg, 95% CI −4.01: −0.51) and cholesterol ratio (mean −0.11, 95% CI −0.19: −0.02) significantly decreased within intervention participants between baseline and one-year follow-up. In conclusion, implementation of the CMD prevention program resulted in the detection of two- to threefold more patients with CMD. A significant drop in systolic blood pressure and cholesterol levels was found after one year of treatment. Modelling of these results should confirm the effect on long term endpoints.

Trial registration: Dutch trial Register number NTR4277.

Abbreviations

CMD
cardiometabolic disease
RCT
randomized controlled trial
BMI
body mass index
CVD
cardiovascular disease
DM2
diabetes type 2
EHR
electronic health record
GP
general practitioner
HDL
high-density-lipoproteins
LDL
low-density-lipoprotein

Keywords

Primary health care
Prevention
Risk assessment
Cardiovascular diseases
Diabetes mellitus
General practitioners
Randomized controlled trial

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