Effect of an intervention to improve the cardiovascular health of family members of patients with coronary artery disease: a randomized trial

Background:

Family members of patients with coronary artery disease (CAD) have higher risk of vascular events. We conducted a trial to determine if a family heart-health intervention could reduce their risk of CAD.

Methods:

We assessed coronary risk factors and randomized 426 family members of patients with CAD to a family heart-health intervention (n = 211) or control (n = 215). The intervention included feedback about risk factors, assistance with goal setting and counselling from health educators for 12 months. Reports were sent to the primary care physicians of patients whose lipid levels and blood pressure exceeded threshold values. All participants received printed materials about smoking cessation, healthy eating, weight management and physical activity; the control group received only these materials. The main outcomes (ratio of total cholesterol to high-density lipoprotein [HDL] cholesterol; physical activity; fruit and vegetable consumption) were assessed at 3 and 12 months. We examined group and time effects using mixed models analyses with the baseline values as covariates. The secondary outcomes were plasma lipid levels (total cholesterol, low-density lipoprotein cholesterol, HDL cholesterol and triglycerides); glucose level; blood pressure; smoking status; waist circumference; body mass index; and the use of blood pressure, lipid-lowering and smoking cessation medications.

Results:

We found no effect of the intervention on the ratio of total cholesterol to HDL cholesterol. However, participants in the intervention group reported consuming more fruit and vegetables (1.2 servings per day more after 3 mo and 0.8 servings at 12 mo; p < 0.001). There was a significant group by time interaction for physical activity (p = 0.03). At 3 months, those in the intervention group reported 65.8 more minutes of physical activity per week (95% confidence interval [CI] 47.0–84.7 min). At 12 months, participants in the intervention group reported 23.9 more minutes each week (95% CI 3.9–44.0 min).

Interpretation:

A health educator–led heart-health intervention did not improve the ratio of total cholesterol to HDL cholesterol but did increase reported physical activity and fruit and vegetable consumption among family members of patients with CAD. Hospitalization of a spouse, sibling or parent is an opportunity to improve cardiovascular health among other family members. Trial registration: clinicaltrials.gov, no {"type":"clinical-trial","attrs":{"text":"NCT00552591","term_id":"NCT00552591"}}NCT00552591.People with a family history of coronary artery disease (CAD) among their first-degree relatives have an increased risk of vascular events.^1–5 This risk is greater if more than 1 relative has heart disease, or if the onset of disease in relatives occurred before age 55.^1–3,5 A concordance of coronary risk factors between patients with heart disease and their spouses has also been reported.^6–10 Although genetic factors are important, familial aggregation of coronary risk factors also plays a role.^9,11,12 Guidelines recommend screening individuals with a positive family history,^13–15 but screening rates are low (< 15%), and interventions are rarely initiated.^16,17 Family members of patients with heart disease may benefit from focused interventions to improve cardiovascular health. Counselling that address physical inactivity and dietary behaviours is central to these interventions; clinical management of risk factors such as tobacco addiction, dyslipidemia, hypertension and dysglycemia are also important. We developed and evaluated a year-long family-based heart-health intervention for the siblings, offspring and spouses of patients admitted to hospital with an acute coronary event.