Combined behavioral interventions best way to reduce heart disease risk, study finds

Current healthcare policies should be modified to encourage these interventions, the study's authors said.

"We need to do a better job finding ways to help people not only change their behaviors, but maintain them over a lifetime," said Nancy T. Artinian, Ph.D., R.N., professor, associate dean for research and director of the Center for Health Research at Wayne State University College of Nursing in Detroit, Mich.

"As healthcare providers, we're pretty good at saying that you are at risk for a disease, you need to lose weight, be more physically active, and eat more fruits and vegetables. While that's easy to say, it's not easy for the person to actually translate it into their everyday life."

The statement is based on an extensive review of peer-reviewed scientific studies. Artinian and her co-authors identified several critical parts of effective behavioral change programs, including healthcare providers using a motivational interviewing technique to encourage patients to make healthier lifestyle choices, counseling patients that occasional setbacks are normal, and scheduling recurring follow-up sessions with patients.

The most effective patient-controlled behaviors include setting specific goals for physical activity and dietary improvements, and keeping track of progress towards their goals, Artinian said.

Artinian and her co-authors analyzed 74 studies conducted among U.S. adults between January 1997 and May 2007. The studies measured the effects of behavioral change on blood pressure and cholesterol levels; physical activity and aerobic fitness; and diet, including reduced calorie, fat, cholesterol and salt intake, and increased fruit, vegetable and fiber consumption.

Cardiovascular disease (CVD) is the leading cause of death in the United States. According to American Heart Association statistics, about 81.1 million adults, or one out of every three people in America, have at least one type of CVD, such as heart attack, stroke or heart failure. If cardiovascular diseases were completely eradicated, life expectancy could increase by nearly seven years.

"Lifestyle change is never easy and often under-emphasized in clinical encounters with our patients. This statement shows what types of programs work and supports the increased need for counseling and goal setting to improve healthy cardiovascular habits," said Ralph Sacco, M.D, president of the American Heart Association. "We need to find more effective ways to make lifestyle change programs available, especially to the groups at highest risk for cardiovascular diseases -- older Americans, African-Americans and people of Hispanic origin."

Sacco added that the first step in making a change is to know your health status, "because a lot of people don't realize they're at risk for heart disease and stroke. The American Heart Association's My Life Check can help identify your risk level and offers simple steps to get started on the path to ideal cardiovascular health."

Although obesity, physical inactivity and poor diet are well recognized as major risk factors for cardiovascular disease, it's often difficult for doctors and nurses to help patients reduce their risk for an extended period. They are faced with numerous obstacles, including time constraints, reimbursement problems and insufficient training in behavioral-change techniques, the statement authors write.

Despite these difficulties, Artinian said policy changes will eventually make critical interventions more readily available.

Federal health reform legislation includes provisions that would improve access to preventive services and help Americans make healthier food choices to control risk factors for heart disease and stroke. For example, the new law requires calorie information on restaurant menus and vending machine products and eliminates co-pays for certain preventive services under Medicare and new private health plans. The legislation also includes funding to support public health interventions at the state and local levels aimed at lowering risk factors for chronic disease.

"I'm looking forward to the future when we will have a healthcare system that gives more weight to the importance of prevention and changing lifestyle behaviors to help people stay healthy and reduce cardiovascular risk," Artinian said.

Co-authors are: Gerald Fletcher, M.D., co-chair; Dariush Mozaffarian, M.D., Dr.PH.; Penny Kris-Etherton, Ph.D., R.D.; Linda Van Horn, Ph.D., R.D.; Alice H. Lichtenstein, D.Sc.; Shiriki Kumanyika, Ph.D., M.P.H.; William E. Kraus M.D.; Jerome L. Fleg, M.D.; Nancy S. Redeker, Ph.D., R.N.; Janet C. Meininger, Ph.D., R.N.; Joanne Banks, R.N., Ph.D.; Eileen M. Stuart-Shor, Ph.D.; Barbara J. Fletcher, R.N., M.N.; Todd D. Miller, M.D.; Suzanne Hughes, M.S.N., R.N.; Lynne T. Braun, Ph.D.; Laurie A. Kopin, M.S., R.N.; Kathy Berra, M.S.N.; Laura L. Hayman, Ph.D., R.N.; Linda J. Ewing, Ph.D., R.N; Philip A. Ades, M.D.; J. Larry Durstine, Ph.D.; Nancy Houston-Miller, B.S.N.; and Lora E. Burke, Ph.D., M.P.H., steering committee co-chair.