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Evidence summaries

Multiple Risk Factor Interventions for Primary Prevention of Coronary Heart Disease

Interventions using counselling and education aimed at behaviour change may not reduce total or coronary heart disease mortality or clinical events in general populations but may be effective in reducing mortality in high-risk hypertensive and diabetic populations.Level of evidence: "C"

A Cochrane review [Abstract] 1 included 55 studies with a total of 163 471 subjects. The median duration of follow up was 12 months (with a range of six months to 12 years).Fourteen studies reported clinical event endpoints. The pooled ORs for total and coronary heart disease (CHD) mortality were 1.00 (95% CI 0.96 to 1.05; statistical heterogeneity I2 =62%; 14 studies, n=139 232) and 0.99 (95% CI 0.92 to 1.07; 11 studies, n= 132 564) respectively. Total mortality and combined fatal and non-fatal cardiovascular events showed benefits from intervention when confined to studies involving people with hypertension (16 studies) and diabetes (5 studies): OR 0.78 (95% CI 0.68 to 0.89; 6 studies, n= 17 852) and OR 0.71 (95% CI 0.61 to 0.83; 4 studies, n= 12 307), respectively. Net changes in systolic and diastolic blood pressure (53 studies), and blood cholesterol (50 studies) were (weighted mean differences) -2.71 mmHg (95% CI -3.49 to -1.93 mmHg), -2.13 mmHg (95% CI -2.67 to -1.58 mmHg) and -0.24 mmol/l (95% CI -0.32 to -0.16 mmol/l) respectively. The OR for reduction in smoking prevalence (20 studies) was 0.87 (95% CI 0.75 to 1.00). Marked heterogeneity (I2 > 85%) for all risk factor analyses was not explained by co-morbidities, allocation concealment, use of antihypertensive or cholesterol-lowering drugs, or by age of trial.

Comment: The quality of evidence is downgraded by study quality and by inconsistency (heterogeneity in interventions and outcomes).

    References

    • Ebrahim S, Taylor F, Ward K, Beswick A, Burke M, Davey Smith G. Multiple risk factor interventions for primary prevention of coronary heart disease. Cochrane Database Syst Rev 2011;(1):CD001561. [PubMed].

Primary/Secondary Keywords