Dose-dependent effects of lifestyle interventions on blood lipid levels: Results from the PREMIER trial

PATIENT EDUCATION AND COUNSELING

卷:102

Article

Dudum, Ramzi^1,2,3  Juraschek, Stephen P.^1,4  Appel, Lawrence J.^1,2 

[1] Johns Hopkins Univ, Welch Ctr Prevent Epidemiol & Clin Res, Baltimore, MD USA

[2] Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA

[3] Johns Hopkins Univ Hosp, Dept Internal Med, Baltimore, MD 21287 USA

[4] Harvard Med Sch, Beth Israel Deaconess Med Ctr, Div Gen Med & Primary Care, Boston, MA 02115 USA

关键词: Cardiovascular disease;    Epidemiology;    Lipids;    Diet;    Randomized trial;    Patient engagement;   

DOI  :  10.1016/j.pec.2019.05.005

来源: Elsevier

【 摘 要 】

Objective: To assess the effects of comprehensive lifestyle modification on low-density lipoprotein cholesterol (LDL-C) levels and whether greater participation in counseling sessions was associated with greater LDL-C reductions. Methods: Multicenter trial of Pre- or Stage 1 hypertensive adults randomized to: (1)Advice alone, (2)'Established' lifestyle intervention implementing physical activity, sodium reduction, and weight loss, if overweight, or (3)'Established + DASH' lifestyle intervention with DASH diet counseling. Both intervention groups received behavioral counseling. We used generalized estimating equations to model the intervention's effects on lipid outcomes. Analyses of number of sessions and lipids were adjusted for demographics and medical history. Results: Among 756 participants (mean age 49.7, 63.2% women, 34.7% black), both lifestyle interventions reduced LDL-C, triglycerides, and total cholesterol (TC) at six months. Compared to the 'Advice' arm, net mean lipid changes in the Established group were: LDL-C of -5.6 mg/dL (p=0.001) and TC of -7.3 mg/dL (p<0.001). Similarly, changes in the 'Established + DASH' group were: LDL-C of -4.0 mg/dL (p=0.03) and TC of -5.7 mg/dL (p=0.006). In dose-response analyses, for every 10-session increase, LDL-C changed by -6.2 mg/dL (p=0.003). Conclusions: Comprehensive lifestyle modification lowers LDL-C with greater benefit among persons who attend more counseling sessions. Practice Implications: Patient engagement is a critical aspect of effective lifestyle interventions. (C) 2019 Elsevier B.V. All rights reserved.

【 授权许可】

Free