Effectiveness of a Family Heart Health Intervention

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DESCRIPTION (provided by applicant): Family members of individuals with coronary heart disease (CHD) are at increased risk of vascular events due to shared genes and lifestyle. Hospitalization for CHD may represent a "motivational moment" for family members to determine their own risk and take action to lower it. We have previously screened over 1500 family members/friends of patients hospitalized with CHD and found that nearly 40 percent had > 3 major risk factors for CHD and only about 10 percent had none. In a pilot study, we showed that a brief intervention to educate participants resulted in significant improvements in lifestyle habits after 3 months. The purpose of this study is to test the effectiveness of the Family Passport To Heart Health Program, a hospital outreach screening and educational program, to identify persons at risk, increase adherence to heart healthy lifestyles, and improve CVD risk factors at 1 year. The design of the study is a randomized controlled clinical trial. Subjects will be assigned to either a control group that receives general health messages about CHD (N = 250) or a special intervention (SI) group (N=250) that receives standardized CHD risk factor screening, personalized education, regular contact by hospital staff, and notification of results to primary physician. Participants will include English or Spanish speaking individuals visiting family members/friends admitted to New York-Presbyterian Hospital with an acute coronary syndrome or revascularization procedure. The intervention is delivered by trained health educators/dieticians and overseen by a physician. The primary outcome is the mean percent reduction in low density lipoprotein (LDL) cholesterol from baseline to 1 year in the SI vs. control group. Secondary outcomes include attainment of the Therapeutic Lifestyle Change Diet at 1 year as defined by the National Cholesterol Education Program Adult Treatment Panel III, the mean percent change in other lipoproteins, blood pressure, body mass index, waist circumference, Framingham risk score, and high sensitivity C reactive protein (hsCRP). Cost-effectiveness of the intervention to reduce LDL levels will be calculated as well as cost per life year saved projected from clinical outcome trials of lipid lowering therapy. The impact of information about hsCRP beyond traditional risk factors on attainment of prevention goals will be assessed. This study will provide important information about the effectiveness of a novel program to identify persons at risk of CHD and increase attainment of Healthy People 2010 Objectives.