AHA.15: Peer-group intervention strategy reduces cardiovascular risk factors

For adults with cardiovascular disease risk factors, a peer-group intervention strategy helped them reduce their blood pressure, improve their exercise, lose weight and quit smoking, according to a randomized, multicenter study in Spain.

Valentin Fuster, MD, PhD, the study chairman and principal investigator and physician-in-chief at Mount Sinai Hospital in New York City, presented the results on Nov. 9 at the American Heart Association (AHA) Scientific Sessions. The findings were simultaneously published online in the Journal of the American College of Cardiology.

“Wider adoption of such a program may have a meaningful impact on cardiovascular health promotion,” Fuster said.

Guster said peer support groups such as Alcoholics Anonymous have been beneficial in treating substance abuse. He added that two previous pilot studies in Spain showed a similar peer support approach for adults with cardiovascular disease risk factors was feasible and effective.

This trial, known as Fifty Fifty, included 543 adults who were between 25 and 50 years old and had at least one cardiovascular disease risk factor: 20 percent had hypertension, 31 percent were smokers, 81 percent were physically inactive and 82 percent were overweight or obese. The mean age of participants was 42, and 71 percent were female.

All of the adults, who lived in seven municipalities in Spain, began the study by participating in six educational workshops related to motivation to change, physical activity, healthful diet, smoking cessation, stress management and self-control of blood pressure.

In January 2014, the participants were randomized in a 1:1 ratio to a peer-group based intervention group or a self-management control group for 12 months.

Each intervention group consisted of approximately 10 adults, including two who were selected as peer educators or leaders. The peer leaders helped the rest of their group adhere to a healthy lifestyle and reduce their cardiovascular disease risk. The monthly sessions lasted 60 to 90 minutes apiece, and the groups also received instruction from health and psychology professionals. The control group received no support following the six initial workshop sessions that occurred before randomization.

The primary outcome was the mean change in the BEWAT (blood pressure, exercise, weight, alimentation and tobacco) score, which Fuster developed and modeled after the American Heart Association’s variables of health. The BEWAT scores includes non-laboratory based health and lifestyle factors. Scores range from 0 to 15, and a higher number suggest fewer risks for cardiovascular disease.

At baseline, the mean BEWAT score was 8.17 in the intervention group and 8.34 in the control group. However, after one year, the mean BEWAT score was significantly higher in the intervention group (8.84) compared with the control group (8.41).

The researchers also found adherence to the monthly intervention group sessions improved participants’ health. Participants who attended at least seven of the 12 sessions were physically active 29.1 minutes per day compared with a mean of 19.7 minutes per day in those who attended fewer than seven sessions. After a year, the mean waist circumference was 98.3 cm in participants who attended at least seven sessions and 101.6 cm in participants attending fewer than seven sessions.

Fuster said the researchers plan on conducting a follow-up assessment of these results in January 2016.

The researchers noted a few limitations of the study, including that participants self-reported their outcomes and participation was voluntary. In addition, 70 percent of the participants were females, which could limit the generalizability of the findings. Further, 16 percent of the participants who enrolled at baseline dropped out of the study, so the researchers said the study could have had a selection bias.

However, when the researchers examined the people who participated in the trial and did not drop out, those in the intervention group had significant improvement in four of the five BEWAT variables (exercise, weight, alimentation and tobacco).