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Lifestyle modification in older versus younger patients with coronary artery disease
OBJECTIVE: To compare the treatment effect on lifestyle-related risk factors (LRFs) in older (≥65 years) versus younger (<65 years) patients with coronary artery disease (CAD) in The Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists 2 (RESPONSE-2) trial. METHODS: The R...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361002/ https://www.ncbi.nlm.nih.gov/pubmed/32179587 http://dx.doi.org/10.1136/heartjnl-2019-316056 |
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author | Jepma, Patricia Jorstad, Harald T Snaterse, Marjolein ter Riet, Gerben Kragten, Hans Lachman, Sangeeta Minneboo, Madelon Boekholdt, S Matthijs Peters, Ron J Scholte op Reimer, Wilma |
author_facet | Jepma, Patricia Jorstad, Harald T Snaterse, Marjolein ter Riet, Gerben Kragten, Hans Lachman, Sangeeta Minneboo, Madelon Boekholdt, S Matthijs Peters, Ron J Scholte op Reimer, Wilma |
author_sort | Jepma, Patricia |
collection | PubMed |
description | OBJECTIVE: To compare the treatment effect on lifestyle-related risk factors (LRFs) in older (≥65 years) versus younger (<65 years) patients with coronary artery disease (CAD) in The Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists 2 (RESPONSE-2) trial. METHODS: The RESPONSE-2 trial was a community-based lifestyle intervention trial (n=824) comparing nurse-coordinated referral with a comprehensive set of three lifestyle interventions (physical activity, weight reduction and/or smoking cessation) to usual care. In the current analysis, our primary outcome was the proportion of patients with improvement at 12 months follow-up (n=711) in ≥1 LRF stratified by age. RESULTS: At baseline, older patients (n=245, mean age 69.2±3.9 years) had more adverse cardiovascular risk profiles and comorbidities than younger patients (n=579, mean age 53.7±6.6 years). There was no significant variation on the treatment effect according to age (p value treatment by age=0.45, OR 1.67, 95% CI 1.22 to 2.31). However, older patients were more likely to achieve ≥5% weight loss (OR old 5.58, 95% CI 2.77 to 11.26 vs OR young 1.57, 95% CI 0.98 to 2.49, p=0.003) and younger patients were more likely to show non-improved LRFs (OR old 0.38, 95% CI 0.22 to 0.67 vs OR young 0.88, 95% CI 0.61 to 1.26, p=0.01). CONCLUSION: Despite more adverse cardiovascular risk profiles and comorbidities among older patients, nurse-coordinated referral to a community-based lifestyle intervention was at least as successful in improving LRFs in older as in younger patients. Higher age alone should not be a reason to withhold lifestyle interventions in patients with CAD. |
format | Online Article Text |
id | pubmed-7361002 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-73610022020-07-16 Lifestyle modification in older versus younger patients with coronary artery disease Jepma, Patricia Jorstad, Harald T Snaterse, Marjolein ter Riet, Gerben Kragten, Hans Lachman, Sangeeta Minneboo, Madelon Boekholdt, S Matthijs Peters, Ron J Scholte op Reimer, Wilma Heart Coronary Artery Disease OBJECTIVE: To compare the treatment effect on lifestyle-related risk factors (LRFs) in older (≥65 years) versus younger (<65 years) patients with coronary artery disease (CAD) in The Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists 2 (RESPONSE-2) trial. METHODS: The RESPONSE-2 trial was a community-based lifestyle intervention trial (n=824) comparing nurse-coordinated referral with a comprehensive set of three lifestyle interventions (physical activity, weight reduction and/or smoking cessation) to usual care. In the current analysis, our primary outcome was the proportion of patients with improvement at 12 months follow-up (n=711) in ≥1 LRF stratified by age. RESULTS: At baseline, older patients (n=245, mean age 69.2±3.9 years) had more adverse cardiovascular risk profiles and comorbidities than younger patients (n=579, mean age 53.7±6.6 years). There was no significant variation on the treatment effect according to age (p value treatment by age=0.45, OR 1.67, 95% CI 1.22 to 2.31). However, older patients were more likely to achieve ≥5% weight loss (OR old 5.58, 95% CI 2.77 to 11.26 vs OR young 1.57, 95% CI 0.98 to 2.49, p=0.003) and younger patients were more likely to show non-improved LRFs (OR old 0.38, 95% CI 0.22 to 0.67 vs OR young 0.88, 95% CI 0.61 to 1.26, p=0.01). CONCLUSION: Despite more adverse cardiovascular risk profiles and comorbidities among older patients, nurse-coordinated referral to a community-based lifestyle intervention was at least as successful in improving LRFs in older as in younger patients. Higher age alone should not be a reason to withhold lifestyle interventions in patients with CAD. BMJ Publishing Group 2020-07 2020-03-16 /pmc/articles/PMC7361002/ /pubmed/32179587 http://dx.doi.org/10.1136/heartjnl-2019-316056 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Coronary Artery Disease Jepma, Patricia Jorstad, Harald T Snaterse, Marjolein ter Riet, Gerben Kragten, Hans Lachman, Sangeeta Minneboo, Madelon Boekholdt, S Matthijs Peters, Ron J Scholte op Reimer, Wilma Lifestyle modification in older versus younger patients with coronary artery disease |
title | Lifestyle modification in older versus younger patients with coronary artery disease |
title_full | Lifestyle modification in older versus younger patients with coronary artery disease |
title_fullStr | Lifestyle modification in older versus younger patients with coronary artery disease |
title_full_unstemmed | Lifestyle modification in older versus younger patients with coronary artery disease |
title_short | Lifestyle modification in older versus younger patients with coronary artery disease |
title_sort | lifestyle modification in older versus younger patients with coronary artery disease |
topic | Coronary Artery Disease |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361002/ https://www.ncbi.nlm.nih.gov/pubmed/32179587 http://dx.doi.org/10.1136/heartjnl-2019-316056 |
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