THE IMPACT OF HEALTH-CARE ADVICE GIVEN IN PRIMARY-CARE ON CARDIOVASCULAR RISK

Objective-To evaluate the additional benefit of ''intensive'' health c are advice through six group sessions, compared with the advice usuall y offered to subjects with multiple risk factors for cardiovascular di sease. Design-Prospective, randomised controlled clinical study tastin g 18 months. Setting-681 subjects aged 30-59 years, with at least two cardiovascular risk factors in addition to moderately high lipid conce ntrations: total cholesterol greater than or equal to 6.5 mmol/l on th ree occasions, triglycerides <4.0 mmol/l, and ratio of low density lip oprotein cholesterol to high density lipoprotein cholesterol >4.0. Mos t (577) of the subjects were men. Main outcome measure-Percentage redu ction in total cholesterol concentration (target 15%); quantification of the differences between the two types of health care advice (intens ive v usual) for the Framingham cardiovascular risk and for individual risk factors. Results-In the group receiving intensive health care ad vice total cholesterol concentration decreased by 0.15 mmol/l more (95 % confidence interval 0.04 to 0.26) than in the group receiving usual advice. The overall Framingham risk dropped by 0.068 more (0.014 to 0. 095) in the group receiving intensive advice, and most of the risk fac tors showed a greater change in a favourable direction in this group t han in the group receiving usual advice, but the differences were seld om significant. The results from questionnaires completed at the group sessions showed that the subjects improved their lifestyle and diet. Conclusion-Limited additional benefit was gained from being in the gro up receiving the intensive health care advice. It is difficult to make an important impact on cardiovascular risk in primary care by using o nly the practice staff. Better methods of communicating the messages n eed to be devised.