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Multiple risk factor interventions for primary prevention of coronary heart disease - PubMed

  • ️Sat Jan 01 2011

Review

Multiple risk factor interventions for primary prevention of coronary heart disease

Shah Ebrahim et al. Cochrane Database Syst Rev. 2011.

Abstract

Background: Multiple risk factor interventions using counselling and educational methods assumed to be efficacious and cost-effective in reducing coronary heart disease (CHD) mortality and morbidity and that they should be expanded. Trials examining risk factor changes have cast doubt on the effectiveness of these interventions.

Objectives: To assess the effects of multiple risk factor interventions for reducing total mortality, fatal and non-fatal events from CHD and cardiovascular risk factors among adults assumed to be without prior clinical evidence CHD..

Search strategy: We updated the original search BY SEARCHING CENTRAL (2006, Issue 2), MEDLINE (2000 to June 2006) and EMBASE (1998 to June 2006), and checking bibliographies.

Selection criteria: Randomised controlled trials of more than six months duration using counselling or education to modify more than one cardiovascular risk factor in adults from general populations, occupational groups or specific risk factors (i.e. diabetes, hypertension, hyperlipidaemia, obesity).

Data collection and analysis: Two authors extracted data independently. We expressed categorical variables as odds ratios (OR) with 95% confidence intervals (CI). Where studies published subsequent follow-up data on mortality and event rates, we updated these data.

Main results: We found 55 trials (163,471 participants) with a median duration of 12 month follow up. Fourteen trials (139,256 participants) with reported clinical event endpoints, the pooled ORs for total and CHD mortality were 1.00 (95% CI 0.96 to 1.05) and 0.99 (95% CI 0.92 to 1.07), respectively. Total mortality and combined fatal and non-fatal cardiovascular events showed benefits from intervention when confined to trials involving people with hypertension (16 trials) and diabetes (5 trials): OR 0.78 (95% CI 0.68 to 0.89) and OR 0.71 (95% CI 0.61 to 0.83), respectively. Net changes (weighted mean differences) in systolic and diastolic blood pressure (53 trials) and blood cholesterol (50 trials) were -2.71 mmHg (95% CI -3.49 to -1.93), -2.13 mmHg (95% CI -2.67 to -1.58 ) and -0.24 mmol/l (95% CI -0.32 to -0.16), respectively. The OR for reduction in smoking prevalence (20 trials) was 0.87 (95% CI 0.75 to 1.00). Marked heterogeneity (I(2) > 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.

Authors' conclusions: Interventions using counselling and education aimed at behaviour change do not reduce total or CHD mortality or clinical events in general populations but may be effective in reducing mortality in high-risk hypertensive and diabetic populations. Risk factor declines were modest but owing to marked unexplained heterogeneity between trials, the pooled estimates are of dubious validity. Evidence suggests that health promotion interventions have limited use in general populations.

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Conflict of interest statement

None known.

Figures

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1.1
1.1. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 1 Total mortality.

1.2
1.2. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 2 Total mortality (individual analysis or cluster).

1.3
1.3. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 3 Total mortality (by allocation concealment).

1.4
1.4. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 4 Total mortality (by co‐morbidity).

1.5
1.5. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 5 Total mortality (by drug treatment).

1.6
1.6. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 6 Total mortality (by era).

1.7
1.7. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 7 Total mortality (by age of study).

1.8
1.8. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 8 Coronary heart disease mortality.

1.9
1.9. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 9 Coronary heart disease mortality (individual analysis or cluster).

1.10
1.10. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 10 Coronary heart disease mortality (by allocation concealment).

1.11
1.11. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 11 Coronary heart disease mortality (by co‐morbidity).

1.12
1.12. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 12 Coronary heart disease (by drug treatment).

1.13
1.13. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 13 Coronary heart disease (by era).

1.14
1.14. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 14 Coronary heart disease mortality (by study age).

1.15
1.15. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 15 Stroke mortality.

1.16
1.16. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 16 Stroke mortality (by allocation concealment).

1.17
1.17. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 17 Stroke mortality (by co‐morbidity).

1.18
1.18. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 18 Stroke mortality (by drug treatment).

1.19
1.19. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 19 Stroke mortality (by era).

1.20
1.20. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 20 Stroke mortality (by study age).

1.21
1.21. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 21 Fatal and non‐fatal clinical events.

1.22
1.22. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 22 Fatal and non‐fatal clinical events (individual analysis or cluster).

1.23
1.23. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 23 Fatal and non‐fatal clinical events (by allocation concealment).

1.24
1.24. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 24 Fatal and non‐fatal clinical events (by co‐morbidity).

1.25
1.25. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 25 Fatal and non‐fatal clinical events (by drug treatment).

1.26
1.26. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 26 Fatal and non‐fatal clinical events (by era).

1.27
1.27. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 27 Fatal and non‐fatal clinical events (by age of study).

1.28
1.28. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 28 Smoking prevalence.

1.29
1.29. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 29 Smoking prevalence (individual analysis or cluster).

1.30
1.30. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 30 Smoking prevalence (by allocation concealment).

1.31
1.31. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 31 Smoking prevalence (by co‐morbidity).

1.32
1.32. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 32 Smoking prevalence (by drug treatment).

1.33
1.33. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 33 Smoking prevalence (by era).

1.34
1.34. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 34 Smoking prevalence (by age of study).

1.35
1.35. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 35 Systolic blood pressure.

1.36
1.36. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 36 Systolic blood pressure (individual analysis or cluster).

1.37
1.37. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 37 Systolic blood pressure (by allocation concealment).

1.38
1.38. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 38 Systolic blood pressure (by co‐morbidity).

1.39
1.39. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 39 Systolic blood pressure (by drug treatment).

1.40
1.40. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 40 Systolic blood pressure (by era).

1.41
1.41. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 41 Systolic blood pressure (by age of study).

1.42
1.42. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 42 Diastolic blood pressure.

1.43
1.43. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 43 Diastolic blood pressure (individual analysis or cluster).

1.44
1.44. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 44 Diastolic blood pressure (by allocation concealment).

1.45
1.45. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 45 Diastolic blood pressure (by co‐morbidity).

1.46
1.46. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 46 Diastolic blood pressure (by drug treatment).

1.47
1.47. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 47 Diastolic blood pressure (by era).

1.48
1.48. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 48 Diastolic blood pressure (by age of study).

1.49
1.49. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 49 Blood cholesterol.

1.50
1.50. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 50 Blood cholesterol (individual analysis or cluster).

1.51
1.51. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 51 Blood cholesterol (by allocation concealment).

1.52
1.52. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 52 Blood cholesterol (by co‐morbidity).

1.53
1.53. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 53 Blood cholesterol (by drug treatment).

1.54
1.54. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 54 Blood cholesterol (by era).

1.55
1.55. Analysis

Comparison 1 Multiple risk factor intervention versus control, Outcome 55 Blood cholesterol (by age of study).

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Swedish RIS 1994 {published data only}
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    1. Agewell S, Fagerberg B, Berglund G, Schmidt C, Wendelhag I, Wikstrand J, et al. Multiple risk factor intervention trial in high risk hypertensive men: comparison of ultrasound intima‐media thickness and clinical outcome during 6 years follow‐up. Journal of Internal Medicine 2001;249:305‐14. - PubMed
    1. Fagerberg B, Wikstrand J, Berglund G, Samuelsson O, Agewall S. Mortality rates in treated hypertensive men with additional risk factors are high but can be reduced. A randomized intervention study. American Journal of Hypertension 1998;11:14‐22. - PubMed
    1. Schmidt C, Fagerberg B, Wikstrand J, Hulthe J. Multiple risk factor intervention reduces cardiovascular risk in hypertensive patients with echolucent plaques in the carotid artery. Journal of Internal Medicine 2003;253:430‐8. - PubMed
    1. Suurkula M, Agewell S, Fagerberg B, Wendelhag, et al. Multiple risk factor intervention in high risk hypertensive patients. Arteriosclerosis, Thrombosis and Vascular Biology 1996;16:462‐70. - PubMed
Take Heart 1995 {published data only}
    1. Glasgow RE, Terborg JR, Hollis JF, Severson HH, Boles SM. Take heart: results from the initial phase of a work‐site wellness program. American Journal of Public Health 1995;85(2):209‐16. - PMC - PubMed
Toobert (MLP) 2005 {published data only}
    1. Toobert D, Glasgow R, Strycker L, Barrera M, Ritzwoller DP, Weidner G. Long‐term effects of the Mediterranean lifestyle program: a randomised clinical trial for post menopausal women with type 2 diabetes. International Journal of Behavioural Nutritional and Physical Activity 2007;4(1):1‐12. - PMC - PubMed
    1. Toobert DJ, Glasgow RE, Strycker LA, Barrera M, Radcliffe JL, Wander RC, et al. Biologic and quality of life outcomes from the Mediterranean lifestyle program. Diabetes Care 2003;26(8):2288‐93. - PubMed
    1. Toobert DJ, Strycker LA, Glasgow RE, Barrera M, Bagdade JD. Enhancing support for health behaviour change among women at risk for heart disease: the Mediterranean lifestyle program. Health Education Research 2002;17(5):574‐85. - PubMed
    1. Toobert DJ, Strycker LA, Glasgow RE, Barrera M, Bagdade JD, et al. Effects of the Mediterranean lifestyle program on multiple risk behaviours and psychosocial outcomes among women at risk for heart disease. Annals of Behavioural Medicine 2005;29(2):128‐37. - PMC - PubMed
Tromso 1991 F {published and unpublished data}
    1. Knutsen S, Knutsen R. The Tromso Survey: The Family Intervention Study ‐ The effect of intervention on some coronary risk factors and dietary habits, a 6‐year follow‐up. Preventive Medicine 1991;20:197‐212. [MEDLINE: ] - PubMed
Tromso 1991 M {published and unpublished data}
    1. Knutsen S, Knutsen R. The Tromso Survey: The Family Intervention Study ‐ The effect of intervention on some coronary risk factors and dietary habits, a 6‐year follow‐up. Preventive Medicine 1991;20:197‐212. [MEDLINE: ] - PubMed
Uusitupa 1993 {published data only}
    1. Laitinen JH, Ahola IE, Sarkkinen ES, Winberg RL, Harmaakorpi‐Iivonen PA, Uusitupa MI. Impact of intensified dietary therapy on energy and nutrient intakes and fatty acid composition of serum lipids in patients with recently diagnosed non‐insulin‐dependent diabetes mellitus. Journal of the American Dietetic Association 1993;93(3):276‐83. [MEDLINE: ] - PubMed
    1. Uusitupa M, Laitinen J, Siitonen O, Vanninen E, Pyorala K. The maintenance of improved metabolic control after intensified diet therapy in recent type 2 diabetes. Diabetes Research & Clinical Practice 1993;19(3):227‐38. [MEDLINE: ] - PubMed
    1. Uusitupa MIJ. Early lifestyle intervention in patients with non‐insulin‐dependent diabetes mellitus and impaired glucose tolerance. Annals of Internal Medicine 1996;28:445‐9. - PubMed
    1. Vanninen E, Uusitupa M, Siitonen O, Laitinen J, Lansimies E. Habitual physical activity, aerobic capacity and metabolic control in patients with newly‐diagnosed type 2 (non‐insulin‐dependent) diabetes mellitus: effect of 1‐year diet and exercise intervention. Diabetologia 1992;35(4):340‐6. [EMBASE: 92117529] - PubMed
WHLP 1998 {published data only}
    1. Kuller LH, Simkin‐Silverman LR, Wing RR, Meilahn EN, Ives DG. Women's healthy lifestyle project: a randomized clinical trial. Circulation 2001;103:32‐7. - PubMed
    1. Simkin‐Silverman L, Wing R, Boraz M, Kuller L. Lifestyle intervention can prevent wight gain during menopause: results from a 5‐year randomised clinical trial. Annals of Behavioral Medicine 2003;26(3):212‐20. - PubMed
    1. Simkin‐Silverman L, Wing RR, Hansen DH, Klem ML, Pasagian‐Macaulay AP, Meilahn EN, et al. Prevention of cardiovascular risk factor elevations in healthy premenopausal women. Preventive Medicine 1995;24(5):509‐17. [MEDLINE: ] - PubMed
    1. Simkin‐Silverman LR, Wing RR, Boraz MA, Meilahn EN, Kuller LH. Maintenance of cardiovascular risk factor changes among middle‐aged women in a lifestyle intervention trial. Women's Health 1998;4(3):255‐71. [MEDLINE: ] - PubMed
WHO Factories 1986 {published and unpublished data}
    1. World Health Organization European Collaborative Group. WHO European collaborative trial in the multifactorial prevention of coronary heart disease. Copenhagen: World Health Organization, 1989. [MEDLINE: ] - PubMed
    1. World Health Organization European Collaborative Group. European collaborative trial of multifactorial prevention of coronary heart disease: final report on the 6‐year results. Lancet 1986;i:869‐75. [MEDLINE: ] - PubMed
    1. World Health Organization European Collaborative Group. Multifactorial trial in the prevention of coronary heart disease: 2. Risk factor changes at two and four years. European Heart Journal 1982;3:184‐90. [MEDLINE: ] - PubMed
Wing 1998 {published data only}
    1. Wing RR, Polley BA, Venditti E, Lang W, Jakicic JM. Lifestyle intervention in overweight individuals with a family history of diabetes. Diabetes Care 1998;21:350‐9. - PubMed

References to studies excluded from this review

Aldana (DPS) 2005 {published data only}
    1. Aldana SG, Barlow M, Smith R, Yanowitz FG, Adams T, Loveday L, et al. The Diabetes Prevention Program. AAOHN Journal 2005;53(11):499‐505. - PubMed
Andersen 1999 {published data only}
    1. Andersen RE, Wadden TA, Bartlett SJ, Zemel B, Verde TJ, Franckowiak SC. Effects of lifestyle activity vs structured aerobic exercise in obese women: a randomized trial [see comments]. JAMA 1999;281(4):335‐40. [MEDLINE: ] - PubMed
Bakx 1997 {published data only}
    1. Bakx JC, Stafleu A, Staveren WA, Hoogen HJ, Weel C. Long‐term effect of nutritional counseling; a study in family medicine. American Journal of Nutrition 1997;65(Suppl):1946S‐50S. - PubMed
Basler 1985 {published data only}
    1. Basler H‐D, Brinkmeier U, Buser K, Haehn K‐D, Molders‐Kober R. Psychological group treatment of obese essential hypertensives by lay therapists in rural general practice settings. Journal of Psychosomatic Research 1985;29(4):383‐91. - PubMed
Becker 2005 {published data only}
    1. Becker D, Yanek L, Johnson W, Garrett D, Moy TF, Reynolds SS, et al. Impact of a community‐based multiple risk factor intervention on cardio vascular risk in black families with a history of premature coronary disease. Circulation 2005;111:1298‐304. - PubMed
Berg 2005 {published data only}
    1. Berg A, Frey I, Landmann U, Deibert P, et al. Weight reduction is feasible‐preliminary results of a controlled, randomised intervention study in overweight adults. [Gewichtsreduktion ist machbar. Halbjahresergebnisse einer klinisch kontrolierten, randomisierten Interventionstudie mit übergewichtigen Erwachsenen]. Ernährungs Umschau 2003;50(10):386‐93.
Blake 1987 {published data only}
    1. Blake R, Doyle M, Straub V, Zweig S, Brent E, Ingman S, et al. A randomized controlled evaluation of an educational program in adults with high psychosocial risk of morbidity. Journal of Family Practice 1987;24:369‐76. [MEDLINE: ] - PubMed
Boylan 2003 {published data only}
    1. Boylan M, Renier C, Knuths J, Haller I. Preventing cardiovascular disease in women. Minnesota Medicine 2003;86(5):52‐6. - PubMed
Brekke 2005b {published data only}
    1. Brekke H, Lenner L, Taskinen M, Mansson J, et al. Lifestyle modification improves risk factors in type 2 diabetes relatives. Diabetes Research and Clinical Practice 2005;68:18‐28. - PubMed
Bruckert 1999 {published data only}
    1. Bruckert E, Lievre M. Primary prevention of cardiovascular disease in the elderly. Atherosclerosis 1999;144:182.
Bruno 1983 {published data only}
    1. Bruno R, Arnold C, Jacobson L, Winick M, Wynder E. Randomized controlled trial of a nonpharmacologic cholesterol reduction program at the worksite. Preventive Medicine 1983;12:523‐32. [MEDLINE: ] - PubMed
Burke 1999 {published data only}
    1. Burke V, Giangiulio N, Gillam HF, Beilin LJ, Houghton S, Houghton S, et al. Health promotion in couples adapting to a shared lifestyle. Health Education Research 1999;14:269‐88. - PubMed
Burke 2003 {published data only}
    1. Burke V, Gianguilio N, Gillam H, Beilin L, et al. Physical activity and nutrition programmes for couples: a randomise controlled trial. Journal of Clinical Epidemiology 2003;56:421‐32. - PubMed
    1. Dzator JA, Hendrie D, Burke V, Gianguilio N, Gillam HF, Beilin LJ, et al. A randomized trial of interactive group sessions achieved greater improvements in nutrition and physical activity at a tiny increase at cost. Journal of Clinical Epidemiology 2004;57:610‐9. - PubMed
Burke 2005 {published data only}
    1. Burke V, Beilin L, Cutt H, Mansour J, Wilson A, Mori TA, et al. Effects of a lifestyle programme on ambulatory blood pressure and drug dosage in treated hypertensive patients: a randomised controlled trial. Journal of Hypertension 2005;23:1241‐9. - PubMed
Cambien 1981 {published data only}
    1. Cambien F, Richard JL, Ducimetiere P, Warnet JM, Kahn J. The Paris Cardiovascular Risk Factor Prevention Trial. Effects of two years of intervention in a population of young men. Journal of Epidemiology & Community Health 1981;35:91‐7. - PMC - PubMed
    1. Cambien F, Richard JL, Jaqueson A, Ducimetiere P. Analysis of the results of a trial where groups have been randomized. The Paris cardiovascular‐prevention trial. Revue d Epidemiologie et de Sante Publique. 1981;29(3):281‐8. [EMBASE: 82013888] - PubMed
Carlberg 1992 {published data only}
    1. Carlberg A, Tibblin G. Patient satisfaction in primary health care. A comparative study of two modes of treatment for hypertension. Family Practice 1992;9:304‐10. [MEDLINE: ] - PubMed
Cicek 2004 {published data only}
    1. Cisek MM, Brzostek T, Gorkiewicz, M. Influence of health education on the occurrence of risk factors for coronary heart disease. Wiadomosci Lekarskie 2004;57(Suppl 1):38‐42. - PubMed
Crouch 1986 {published data only}
    1. Crouch M, Sallis J, Farquhar JW, Haskell W, Ellsworth N, King A, et al. Personal and mediated health counseling for sustained dietary reduction of hypercholesterolaemia. Preventive Medicine 1986;15:282‐91. [MEDLINE: ] - PubMed
Da Qing 1997 {published data only}
    1. Pan XR, Li GW, Hu YH, Wang JX, Yang WY, An ZX, et al. The effect of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care 1997;20:537‐544. [MEDLINE: ] - PubMed
Davey‐Smith 2005 {published data only}
    1. Davey Smith G, Bracha Y, Svendsen KH, Neaton JD, Haffner SM, Kuller LH, et al. Incidence of type 2 diabetes in the randomised multiple risk factor intervention trial. Annals of Internal Medicine 2005;142:313‐22. - PubMed
Domarkene 1990 {published data only}
    1. Domarkene S, Baubinene A, Chazova L, Kalinina A, Meimanaliev T, Shleifer E, et al. Efficiency of a cooperative program on multifactor prevention of coronary heart disease. Results of a 3 year follow up. Kardiologiia 1990;30:95‐8. [MEDLINE: ] - PubMed
DPP 1999 {published data only}
    1. The Diabetes Prevention Program. Design and methods for a clinical trial in the prevention of type 2 diabetes. Diabetes Care 1999;22(4):623‐34. [MEDLINE: ] - PMC - PubMed
    1. The Diabetes Prevention Program: baseline characteristics of the randomized cohort. The Diabetes Prevention Program Research Group. Diabetes Care 2000;23(11):1619‐29. - PMC - PubMed
DPPRG 2002 {published data only}
    1. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine 2002;346(6):393‐403. - PMC - PubMed
Dunn 1997 {published data only}
    1. Dunn AL, Marcus BH, Kampert JB, Garcia ME, Kohl HW 3rd, Blair SN. Reduction in cardiovascular disease risk factors: 6‐month results from Project Active. Preventive Medicine 1997;26(6):883‐92. [MEDLINE: ] - PubMed
Eberle 2003 {published data only}
    1. Eberly L, Cohen J, Prineas R, Yang l, Intervention Trial Research group. Impact of incident diabetes and incident nonfatal cardiovascular disease on 18 year mortality. Diabetes Care 2003;26(3):848‐54. - PubMed
Edye 1989 {published data only}
    1. Edye B, Mandryk J, Frommer M, Healey S, Ferguson D. Evaluation of a worksite programme for the modification of cardiovascular risk factors. Medical Journal of Australia 1989;150:574‐81. [MEDLINE: ] - PubMed
Elliot 2007 {published data only}
    1. Elliot D, Goldberg L. Kuehl K, Moe E, Breger RK, Pickering MA. The PHLAME (Promoting Healthy Lifestyles: Alternative Models Effect) firefighter study. Outcomes of two models of behaviour change. Journal of Occupational Environmental Medicine 2007;49:204‐13. - PubMed
Esposito 2003 {published data only}
    1. Esposito K, Pontillo A, Palo C, Giugliano G, Masella M, Marfella R, et al. Effect on weight loss and life style changes on vascular inflammatory markers in obese women. JAMA 2003;289(14):1799‐804. - PubMed
Ferro 2001 {published data only}
    1. Ferro A, Walton R. Racial differences in the effectiveness of non‐pharmacologic treatment of hypertension. Hypertension 2001;38:24. - PubMed
Fielding 1994 {published data only}
    1. Fielding JE, Knight K, Mason T, Klesges RC, Pelletier KR. Evaluation of the IMPACT blood pressure program. Journal of Occupational Medicine 1994;36(7):743‐6. [MEDLINE: ] - PubMed
    1. Fielding JE, Mason T, Kinght K, Klesges R, Pelletier KR. A randomized trial of the IMPACT worksite cholesterol reduction program. American Journal of Preventive Medicine 1995;11(2):120‐3. - PubMed
Fox 1996 {published data only}
    1. Fox AA, Thompson JL, Butterfield GE, Gylfadottir U, Moynihan S, Spiller G. Effects of diet and exercise on common cardiovascular disease risk factors in moderately obese older women. American Journal of Clinical Nutrition 1996;63(2):225‐33. [MEDLINE: ] - PubMed
Frommer 1990 {published data only}
    1. Frommer MS, Mandryk JA, Edye BV, Healey S, Berry G, Ferguson DA. A randomised controlled trial of counseling in a workplace setting for coronary heart disease risk factor modification: effects on blood pressure. Asia‐Pacific Journal of Public Health 1990;4(1):25‐33. [MEDLINE: ] - PubMed
Fuchs 1993 {published data only}
    1. Fuchs Z, Viskoper JR, Drexler I, Nitzan H, Lubin F, Berlin S, et al. Comprehensive individualised nonpharmacological treatment programme for hypertension in physician‐nurse clinics: two year follow‐up. Journal of Human Hypertension 1993;7(6):585‐91. [MEDLINE: ] - PubMed
Fullard 1987 {published data only}
    1. Fullard E, Fowler G, Gray M. Promoting prevention in primary care: controlled trial of low technology, low cost approach. BMJ 1987;294:1080‐2. [MEDLINE: ] - PMC - PubMed
Gaede 2003 {published data only}
    1. Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. New England Journal of Medicine 2003;348(5):383‐93. - PubMed
    1. Gaede P, Vedel P, Parving H, Pederen O. Intensified multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: the Steno type 2 randomised study. Lancet 1999;353:617‐22. - PubMed
    1. Pedersen O, Gaede P. Intensified multifactorial intervention and cardiovascular outcome in type 2: the Steno type 2 randomised study. Metabolism 2003;52(8):19‐23. - PubMed
Gemson 1990 {published data only}
    1. Gemson DH, Sloan RP, Messeri P, Goldberg IJ. A public health model for cardiovascular risk reduction. Impact of cholesterol screening with brief nonphysician counseling. Archives of Internal Medicine 1990;150:985‐9. [MEDLINE: ] - PubMed
Gemson 1995 {published data only}
    1. Gemson DH, Sloan RP. Efficacy of computerized health risk appraisal as part of a periodic health examination at the worksite. American Journal of Health Promotion 1995;9:462‐6. - PubMed
German 1994 {published data only}
    1. German C, Heierle C, Zunzunegui MV, Contreras E, Blanco P, Ruiz E, et al. The control of arterial hypertension in primary care: the evaluation of a program of self‐care [El control de la hipertension arterial en atencion primaria: evaluacion de un programa de autocuidados]. Atencion Primaria 1994;13(1):3‐7. [MEDLINE: ] - PubMed
Goldhaber‐Fiebert 2003 {published data only}
    1. Goldhaber‐Fiebert J, Goldhaber‐Fiebert S, Tristran M, Nathan D. Randomised controlled community based nutrition and exercise intervention improves glycemia and cardiovascular risk factors in type 2 diabetic patients in rural Costa Rica. Diabetes Care 2003;26(1):24‐9. - PubMed
Gomel 1993 {published data only}
    1. Gomel M, Oldenburg B, Simpson JM, Owen N. Work‐site cardiovascular risk reduction: a randomized trial of health risk assessment, education, counseling, and incentives. American Journal of Public Health 1993;83:1231‐8. [MEDLINE: ] - PMC - PubMed
    1. Gomel MK, Oldenburg B, Simpson JM, Chilvers M, Owen N. Composite cardiovascular risk outcomes of a work‐site intervention trial. American Journal of Public Health 1997;87(4):673‐6. - PMC - PubMed
Gordon 1997 {published data only}
    1. Gordon NF, Scott CB, Levine BD. Comparison of single versus multiple lifestyle interventions: are the antihypertensive effects of exercise training and diet‐induced weight loss additive?. American Journal of Cardiology 1997;79(6):763‐7. [MEDLINE: ] - PubMed
Gordon 2002 {published data only}
    1. Gordon N, English C, Contractor A, Salmon R, Leighton RF, Franklin BA, et al. Effectiveness of three models for comprehensive cardiovascular disease risk reduction. American Journal of Cardiology 2002;89(1):1263‐8. - PubMed
Gump 2003 {published data only}
    1. Gump B, Matthews K. Special intervention reduces CVD mortality for adherent participants in the multiple risk factor intervention trial. Annals of Behavioural Medicine 2003;26(1):61‐8. - PubMed
Gysan 2004 {published data only}
    1. Gysan DB, Latsch J, Bjarnason‐Wehrens B, Albus C, Falkowski G, Herold G, et al. The PreFord Study. A prospective cohort study to evaluate the risk of a cardiovascular event (overall‐collective) as well as a prospective, randomized, controlled, multicentre clinical intervention study (high‐risk‐collective) on primary prevention of cardiovascular diseases in the Ford Motor Company employees in Germany [Die PraeFord Studie]. Zeitschrift für Kardiologie 2004;93(2):131‐6. - PubMed
Hanlon 1995 {published data only}
    1. Hanlon P, McEwan J, Gilmour H, Tannahill C, Tannahill A, Kelly M. Health checks and coronary risk: further evidence from a randomized controlled trial. BMJ 1995;311:1609‐13. [MEDLINE: ] - PMC - PubMed
Haskell 1988 {published data only}
    1. Haskell WL, Fair J, Sanders W, Alderman EL. New methodologies for studying the prevention of atherosclerosis. Annals of Clinical Research 1988;20(1‐2):39‐45. [MEDLINE: ] - PubMed
Hedberg 1998 {published data only}
    1. Hedberg GE, Wikstrom‐Frisen L, Janlert U. Comparison between two programmes for reducing the levels of risk indicators of heart diseases among male professional drivers. Occupational & Environmental Medicine 1998;55(8):554‐61. - PMC - PubMed
Hopman‐Rock {published data only}
    1. Hopman‐Rock M, Westhoff M. Health education and exercise stimulation for older people: development and evaluation of the program "Healthy and Vital" [Gezondheidsvoorlichting en bewegingsstimulering voor ouderen: ontwikkeling en evaluatie van het programma "Gezond & Vitaal"]. Tijdschrift Voor Gerontologie En Geriatrie 2002;33:56‐63. - PubMed
Huang 2001 {published data only}
    1. Huang E, Meigs J, Singer D. The effects of intervention to prevent cardiovascular disease in patients with type 2 diabetes mellitus. American Journal of Medicine 2001;111(8):633‐42. - PubMed
Inter99 2003 {published data only}
    1. Jorgensen T, Borch‐Johnsen K, Thomsen T, Ibsen H, Glümer C, Pisinger C, et al. A randomised non‐pharmacological intervention study for the prevention of Ischaemic heart disease: baseline results Inter99. European Journal of Cardiovascular Prevention Rehabilitation 2003;10:377‐86. - PubMed
    1. Toft U, Kristoffersen L, Aadahl M, Huth Smith L, et al. Diet and exercise intervention in a general population‐mediators of participation and adherence: the Inter99 study. European Journal of Public Health 2006;12:1‐9. - PubMed
Jiang 2004 {published data only}
    1. Jiang B, Wang W, Wu S, Hong Z. Control effect of health education on body mass index of community population. Wei Sheng Yan Jui 2004;33(1):98‐100. - PubMed
Jula 1990 {published data only}
    1. Jula A, Ronnemaa J, Rastas A, Karvetti R‐L, Muki J. Long‐term nonpharmacological treatment for mild to moderate hypertension. Journal of Internal Medicine 1990;227:413‐21. [MEDLINE: ] - PubMed
Kamioka 2006 {published data only}
    1. Kamioka H, Nakamura Y, Yazaki T, Uebaba K, Mutoh Y, Okada S, et al. Comprehensive heath eduction combining hot sap bathing and lifestyle education in middle‐aged and elderly women: one year follow‐up on randomised control trial of three and six month interventions. Journal of Epidemiology 2006;16(1):35‐44. - PMC - PubMed
Karlehagen 2003 {published data only}
    1. Karlehagen S, Ohlson C. Primary prevention of cardiovascular disease by an occupational health service. Preventative Medicine 2003;37:219‐25. - PubMed
Kawakami 1999 {published data only}
    1. Kawakami N, Haratani T, Iwata N, Imanaka Y, Murata K, Araki S. Effects of mailed advice on stress reduction among employees in Japan: a randomized controlled trial. Industrial Health 1999;37(2):237‐42. [MEDLINE: ] - PubMed
Ketola 2001 {published data only}
    1. Ketola E, Makela M, Klockars M. Individualised multifactorial lifestyle intervention trial for high‐risk cardiovascular patients in primary care. British Journal of General Practice 2001;51:291‐4. - PMC - PubMed
Kisioglu 2004 {published data only}
    1. Kisioglu A, Aslan B, Ozturk M, Aykut M, Ilhan I. Improving control of high blood pressure among middle‐aged Turkish women of low socio‐economic status through public health training. Croatian Medical Journal 2004;45(4):477‐82. - PubMed
Knappe 1982 {published data only}
    1. Knappe J, Heinrich J, Duck KD. On the efficacy of a programme of the prevention of cardio‐vascular diseases [Zur Wirksamkeit eines Präventionsprogramms gegen Herz‐Kreislauf‐Krankheiten]. Zeitschrift für die Gesamte Innere Medizin und Ihre Grenzgebiete 1982;37(19):633‐41. [EMBASE: 83029552] - PubMed
Ko 2004 {published data only}
    1. Ko G. Effects of structured health education programme by a diabetic education nurse on cardiovascular risk factors in Chinese Type 2 diabetic patients: a 1 year prospective randomised trial. Diabetic Medicine 2004;21:1274‐9. - PubMed
Kreuter 1996 {published data only}
    1. Kreuter MW, Strecher VJ. Do tailored behavior change messages enhance the effectiveness of health risk appraisal. Health Education Research 1996;11:97‐105. - PubMed
Lasater 1986 {published data only}
    1. Lasater TM, Wells BL, Carleton RA, Elder JP. The role of churches in disease prevention research studies. Public Health Reports 1986;101(2):125‐31. [MEDLINE: ] - PMC - PubMed
Lauritzen 1995 {published data only}
    1. Engberg MD, Christensen B, Karlsmose B, Lous J, Lauritzen T. General health screenings to improve cardiovascular risk profiles: a randomized controlled trial in general practice with 5 year follow‐up. Journal of Family Practice 2002;51(6):546‐52. - PubMed
    1. Lauritzen T, Leboeuf‐Yde C, Lunde IM, Nielsen KD. Ebeltoft project: baseline data from a five‐year randomized, controlled, prospective health promotion study in a Danish population. British Journal of General Practice 1995;45(399):542‐7. [MEDLINE: ] - PMC - PubMed
Leighton 1990 {published data only}
    1. Leighton RF, Repka FJ, Birk TJ, Lynch DJ, Bingle JF, Gohara AF, et al. The Toledo Exercise and Diet Study. Results at 26 weeks. Archives of Internal Medicine 1990;150(5):1016‐20. [MEDLINE: ] - PubMed
Lindahl 1998 {published data only}
    1. Lindahl B, Nilsson TK, Asplund K, Hallmans G. Intense nonpharmacological intervention in subjects with multiple cardiovascular risk factors: decreased fasting insulin levels but only a minor effect on plasma plasminogen activator inhibitor activity. Metabolism: Clinical & Experimental 1998;47(4):384‐90. [MEDLINE: ] - PubMed
Little 2004 {published data only}
    1. Little P, Kelly J, Barnett J, Dorward M, Margetts B, Warm D. Randomised controlled trial of dietary advice for patients with single high blood pressure reading in primary care. BMJ 2004;328:1054‐9. - PMC - PubMed
Lovibond 1986 {published data only}
    1. Lovibond S, Birrell P, Langeluddecke P. Changing coronary heart disease risk‐factor status: the effects of three behavioural programs. Journal of Behavioural Medicine 1986;9:414‐36. [MEDLINE: ] - PubMed
Macdonald 1990 {published data only}
    1. Macdonald NJ, Stark S, et al. Multiple risk factor intervention in the prevention of coronary heart disease [abstract]. Clinical Science 1990;78(Suppl 22):6P.
Martinez‐Amenos 1990 {published data only}
    1. Martínez‐Amenós A, Fernández Ferré ML, Mota Vidal C, Alsina Rocasalbas J. Evaluation of two educative models in a primary care hypertension programme. Journal of Human Hypertension 1990;4:362‐4. [MEDLINE: ; CN‐00060437] - PubMed
McCance 1985 {published data only}
    1. McCance KL, Eutropius L, Jacobs MK, Williams RR. Preventing coronary heart disease in high‐risk families. Research in Nursing & Health 1985;8(4):413‐20. [MEDLINE: ] - PubMed
McCann 1997 {published data only}
    1. McCann TJ, Criqui MH, Kashani IA, Sallis JF, Calfas KJ, Langer RD, et al. A randomized trial of cardiovascular risk factor reduction: patterns of attrition after randomization and during follow‐up. Journal of Cardiovascular Risk 1997;4(1):41‐6. [MEDLINE: ] - PubMed
McMahon 2002 {published data only}
    1. McMahon A, Hodgins M, Kelleher C. Feasibility of a men's health promotion programme in Irish primary care. Irish Journal of Medical Science 2002;171(1):20‐3. - PubMed
Meimanaliev 1991 {published data only}
    1. Meimanaliev T, Shleifer E, Aitbaev K, Aitmurzaeva G, Gilfanova V, Podgurskaya L, et al. Prevalence of ischaemic heart disease risk factors among the male population in Frunze aged 40‐59 years and results of a five‐year prevention programme. Cor et Vasa 1991;33:451‐7. [MEDLINE: ] - PubMed
Miemanaliev 1993 {published data only}
    1. Meimanaliev T, Oteva E, Aitbaev K, Maslennikov A, Nikolaeva A, Shterental I, et al. Prevalence of main risk factors among probands with a history of early myocardial infarction and their relatives. Terapevticheskii Arkhiv 1993;65:28‐30. [MEDLINE: ] - PubMed
Miller 2002 {published data only}
    1. Miller E, Erlinger T, Young D, Jehn M, Charleston J, Rhodes D, et al. Results of diet, exercise, and weight loss intervention trial (DEW‐IT). Hypertension 2002;40:612‐18. - PubMed
Murray 1986 {published data only}
    1. Murray DM, Luepker RV, Pirie PL, Grimm RH Jr, Bloom E, Davis MA, et al. Systematic risk factor screening and education: a community‐wide approach to prevention of coronary heart disease. Preventive Medicine 1986;15(6):661‐72. [MEDLINE: ] - PubMed
Nieman 2002 {published data only}
    1. Nieman D, Brock D, Butterworth D, Utter A, Nieman CC. Reducing diet and/or exercise training decreases the lipid and lipoprotein risk factors of moderately obese women. Journal of the American College of Nutrition 2002;21(4):344‐50. - PubMed
Nikitin 1991 {published data only}
    1. Nikitin Y, Bondareva Z, Oteva E, Filimonova T. Serum lipid composition in healthy subjects and patients of senile age and long livers. Klinicheskaya Meditsina 1991;69:32‐5. - PubMed
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