Multiple lifestyle interventions for secondary prevention of coronary heart disease: a meta-analysis Chiara de Waure

Background Cardiovascular diseases (CVD) are the leading cause of death in European countries even though mortality rates have decreased since 1960. In particular, coronary heart disease (CHD) represents about 50% of CVD. Prevention is considered a milestone in reducing the burden of CVD. With this respect multiple lifestyle interventions may be carried out both in primary and secondary prevention. A Cochrane review on primary prevention of CHD in general population has suggested that multiple lifestyle interventions could be more beneficial in subjects at high risk. The aim of this study was to assess the efficacy of multiple lifestyle interventions in patients at high risk because already affected by CHD. Methods A systematic review and meta-analysis of randomized controlled trials (RCTs) with at least 6 month of follow up was done. Literature search was performed on Cochrane Library, Medline and Embase until March 31st 2012. Only RCTs dealing with patient-tailored multiple lifestyle interventions aimed at reducing at least two risk factors in patients with established CHD were selected. Fatal and non-fatal cardiovascular events were considered as primary endpoints whereas overall mortality and CVD associated hospital readmissions as secondary ones. Multiple lifestyle interventions were compared to usual care alone by means of relative risk (RR) with 95% confidence interval (95%CI). Results The search yielded 854 articles for a total of 14 unique RCTs which were considered eligible. All articles dealt with interventions which included diet and nutrition recommendations and physical activity instructions/sessions. The majority (78.6%) included smoking recommendation/quitting programs also. Nine out of 14 did contribute to the quantitative analysis. By meta-analysis, a significant 18% reduction (RR 0.82; 95%CI 0.69-0.98) was found with respect to fatal cardiovascular events. Furthermore, a non-significant reduction of non-fatal events, overall mortality and hospital readmissions was detected (RR 0.85, 0.94 and 0.87 respectively). Conclusions Multiple lifestyle interventions aimed at improving modifiable risk factors in patients with established CHD reduce the risk for fatal cardiovascular events and should be considered in secondary prevention of CHD. Key message Multiple lifestyle interventions reduce the risk for fatal cardiovascular events in patients with established coronary heart diseases and should be considered in secondary prevention programs. 6th European Public Health Conference: Friday 15 November, 15:30–16:30 177 Downloaded from http://eurpub.oxfordjournals.org/ by guest on February 16, 2014