A multidimensional integrative medicine intervention to improve cardiovascular risk
A multidimensional integrative medicine intervention to improve cardiovascular risk
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DOI：
10.1111/j.1525-1497.2006.00495.x
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发表时间：
2006-07-01
影响因子：
5.7
通讯作者：
Gaudet, Tracy W.
中科院分区：
文献类型：
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作者：
Edelman, David;Oddone, Eugene Z.;Gaudet, Tracy W.
背景：中西医结合是一种个性化的、以患者为中心的健康方法，将全人模式与循证医学相结合。基于中西医结合理论的干预措施尚未作为降低心血管风险的策略得到检验。我们的目的是确定个性化健康计划（PHP），一种基于中西医结合理论和原则的干预措施，是否能降低10年冠心病（CHD）的风险。方法：我们进行了一项随机对照试验，纳入154例年龄在45岁及以上、已知心血管危险因素1项及以上的门诊患者。受试者来自学术医疗中心附近的初级保健诊所，干预在一所大学的中西医结合中心进行。在进行健康风险评估后，干预组的每个受试者都与健康教练和医疗服务提供者一起制定个性化的健康计划。该计划确定了每个受试者需要改变的重要健康行为；行为的选择是由心血管风险降低和每个个体受试者的利益驱动的。然后教练协助每个受试者实施她/他的健康计划。实施过程中使用的技术包括正念冥想、放松训练、压力管理、激励技巧、健康教育和指导。随机分配到对照组的受试者接受常规护理（UC），不进行干预。我们的主要结局指标是10年冠心病风险，通过标准Framingham风险评分来衡量，并在基线、5个月和10个月进行评估。采用线性混合效应模型评估各组之间的差异，时间和研究组为自变量。结果：UC组（n = 77）和PHP组（n = 77）的基线10年冠心病风险分别为11.1%和9.3%。干预10个月后，UC组冠心病风险降至9.8%，干预组降至7.8%。基于线性混合效应模型，两组患者的风险改善率差异有统计学意义（P = 0.04）。在二次分析中，与UC相比，PHP组的受试者每周运动天数增加（3.7 vs 2.4, P = 0.002），并且与UC相比，在研究开始时超重的受试者在PHP组中体重减轻更大（P = 0.06）。结论：基于中西医结合原则的多维干预可能通过增加运动和改善体重减轻来降低冠心病的风险。
BACKGROUND: Integrative medicine is an individualized, patient-centered approach to health, combining a whole-person model with evidence-based medicine. Interventions based in integrative medicine theory have not been tested as cardiovascular risk-reduction strategies. Our objective was to determine whether personalized health planning (PHP), an intervention based on the theories and principles underlying integrative medicine, reduces 10-year risk of coronary heart disease (CHD).METHODS: We conducted a randomized, controlled trial among 154 outpatients age 45 or over, with 1 or more known cardiovascular risk factors. Subjects were enrolled from primary care practices near an academic medical center, and the intervention was delivered at a university Center for Integrative Medicine. Following a health risk assessment, each subject in the intervention arm worked with a health coach and a medical provider to construct a personalized health plan. The plan identified specific health behaviors important for each subject to modify; the choice of behaviors was driven both by cardiovascular risk reduction and the interests of each individual subject. The coach then assisted each subject in implementing her/his health plan. Techniques used in implementation included mindfulness meditation, relaxation training, stress management, motivational techniques, and health education and coaching. Subjects randomized to the comparison group received usual care (UC) without access to the intervention. Our primary outcome measure was 10-year risk of CHD, as measured by a standard Framingham risk score, and assessed at baseline, 5, and 10 months. Differences between arms were assessed by linear mixed effects modeling, with time and study arm as independent variables.RESULTS: Baseline 10-year risk of CHD was 11.1% for subjects randomized to UC (n = 77), and 9.3% for subjects randomized to PHP (n = 77). Over 10 months of the intervention, CHD risk decreased to 9.8% for UC subjects and 7.8% for intervention subjects. Based on a linear mixed-effects model, there was a statistically significant difference in the rate of risk improvement between the 2 arms (P = .04). In secondary analyses, subjects in the PHP arm were found to have increased days of exercise per week compared with UC (3.7 vs 2.4, P = .002), and subjects who were over-weight on entry into the study had greater weight loss in the PHP arm compared with UC (P = .06).CONCLUSIONS: A multidimensional intervention based on integrative medicine principles reduced risk of CHD, possibly by increasing exercise and improving weight loss.