Cardiovascular diseases (CVD), including heart diseases and stroke, are the leading causes of death in the United States. Every year, more than one million Americans have a heart attack, and nearly 800,000 have a stroke. In 2010, heart disease alone is expected to cost the country more than $316 billion in health care and lost productivity.
Both lifestyle changes and medication can reduce the risk of CVD, and researchers are combining these approaches in the hope of identifying an intervention that is practical to use in primary care medical offices. The researchers are adapting two previously tested interventions—the New Leaf lifestyle counseling program and the Heart to Heart Medication Adherence Intervention—and updating them to meet current guidelines for diet and use of aspirin and cholesterol-controlling drugs (statins).
The research team is combining these two interventions and delivering the combined intervention in two formats: web-based and counselor-based. Each format has the same content, but the web-based advice is accessed through the Internet by clients at home, a community site, or a primary care office. The other format involves sessions delivered to clients by a counselor either in person at a primary care office or by telephone. The researchers will compare how effective each format is in reducing the participants’ risk of coronary heart disease. They also will determine the interventions’ effect on participants’ diet, physical activity, smoking status, medication adherence, and other health indicators. In addition, the team will compare the two formats’ cost-effectiveness and how well the patients, office staff, and clinicians accept the interventions.
Recruited from five family practices, 600 patients representing the geographic and ethnic diversity of North Carolina are taking part in this study. Half of the participants are randomly assigned to the web-based intervention; the other half to the counselor-based version. Both groups also will get information on local resources, such as gyms and farmers markets, that can help participants maintain a healthy lifestyle.