family heart health program: randomized, controlled trial

Conditions: Coronary Heart Disease

Summary: background: family members (spouses, siblings, offspring) of patients with coronary heart disease (chd) may themselves be at increased risk for developing chd for genetic, biochemical and/or behavioural reasons. targeted approaches aimed at family members of those with established chd may be a cost-effective way to identify high-risk persons and link them to effective risk factor modification. during pilot testing we found 29% of family members of patients recently hospitalized at our institution had ≥ 3 chd risk factors. encouragingly, they indicated high levels of "readiness" to change underlying risk behaviours such as cigarette smoking and physical inactivity. we have developed a 12-week family heart health program featuring a personal plan for achieving risk factor goals and weekly contact with a heart health educator. this intervention needs to be fully tested. research aims: in this study, we will: 1. compare the effects of a targeted family heart health (fhh) screening, counselling and follow-up program versus usual care (uc) for reducing participants total cholesterol/high density lipoprotein (tc/hdl) ratio 52 weeks after program entry, in family members of patients recently hospitalized with chd; 2. compare the effects of the fhh program versus uc on modifiable components comprising the framingham score, including: smoking status; systolic blood pressure; total cholesterol; and high density lipoprotein cholesterol; 3. compare the effects of the fhh program versus uc on: lifestyle-related factors (dietary patterns, leisure time exercise, body composition); medication use (anti-lipemic medications, anti-hypertensive medications, pharmacotherapies for smoking cessation); and use of healthcare resources (physician visits, hospitalization days, number of laboratory and diagnostic tests and procedures).


Eligibility criteria:
inclusion criteria: * spouse, offspring or sibling of patient hospitalized at uohi within the past 5 years for: 1. acute coronary syndrome (acs); 2. elective percutaneous coronary intervention (pci); or 3. bypass surgery (cabg); * willing to provide informed consent; * at least one of the following modifiable risk factors: 1. current smoker; 2. systolic blood pressure ≥ 140 and or diastolic bp ≥ 90 and/or currently on medication to treat high blood pressure; 3. total cholesterol/hdl-cholesterol ratio ≥ 5.0 and/or on antilipemic medication; 4. abdominal obesity (for men, waist circumference \> 102 cm; for women, waist circumference \> 88cm); 5. physical inactivity \[\<150 min mod, 5-7 d/week or \<100 min vig, 4-7 d/week\] * geographically available for assessment, intervention and follow-up. exclusion criteria: 1. unable to understand english or french; 2. history of diabetes mellitus or any atherosclerotic disease; 3. fasting glucose ≥ 7.0 mmol/l at screening; 4. presence of life threatening illness (e.g., known or suspected cancer or other disease with a life expectancy of less than five years); 5. chronic kidney disease and/or undergoing dialysis; 6. active liver disease; 7. pregnant or planning to become pregnant within the next year; 8. cognitive impairment; 9. other family member already participating in study.

Keywords: family risk behavior modification lifestyle change prevention of chd health care costs