Community Site Coronary Risk Control in Black Families
Condition: Cardiovascular Diseases; Heart Diseases; Coronary Disease; Coronary Heart Disease Risk Reduction
MeSH terms: Cardiovascular Diseases; Heart Diseases; Coronary Disease; Coronary Artery Disease; Myocardial Ischemia
Study type: Observational

Summary: 
      To test the effectiveness of a community site neighborhood health worker/nurse (NHW/N) case
      management strategy for coronary heart disease risk reduction compared with usual care in
      apparently healthy African American siblings of persons with documented premature coronary
      heart disease.
    

Detailed description: 
      BACKGROUND:

      The rationale for this program proceeded from the markedly increased risk of initial coronary
      events in siblings with coronary artery disease with onset before age 50. There is an excess
      of treatable coronary heart disease risk factors in such siblings and a high prevalence of
      adult atherosclerosis.

      DESIGN NARRATIVE:

      The study recruited 364 siblings of individuals with early coronary disease. Eligible
      subjects were randomized to community-based care (CBC) or enhanced primary care (EPC) with a
      community health site neighborhood health worker/nurse for 1 year follow up. Intervention
      participants were stratified based on results of treadmill testing to either more or less
      aggressive management of their lipids according to National Cholesterol Education Program
      guidelines. All positive participants on the exercise stress test were directly referred to
      their physicians. Diabetics were referred to their primary physician for treatment.
      Intervention in the intervention group was carried out on traditional coronary heart disease
      (CHD) risk factors including diet, physical activity, blood pressure, LDL cholesterol, and
      cigarette smoking. The intervention built on a prior sibling study in Blacks and whites.

      The approach was that, rather than carrying out the intervention at the central John Hopkins
      Clinic, thus requiring transportation of potentially anxious participants to a strange
      environment, the new interventions were carried out by trained local NHWs in a more
      accessible local community site. The nutrition interventions used fat counters that focused
      on total fat gram goals, and intervention was carried out by the NHW/N with assistance from
      cookbooks appropriate for African American households. Siblings were requested to come
      monthly for dietary counseling. Smoking cessation interventions used individual counseling
      previously carried out by the investigators. Smoking assessment included self-report and
      measures of carbon monoxide (CO) in expired air. Study physicians carried out pharmacologic
      interventions for blood pressure, lipids and lipoproteins. Diabetes treatment was through
      referral to the patient's private physician. Nurses provided oversight to NHWs.

      Neighborhood health workers were trained and certified in taking blood pressure (BP),
      phlebotomy, and CO measurements at the Center for Health Promotion at Johns Hopkins, which
      had an NHW training program for blood pressure. Outcomes measures included changes in blood
      pressure, smoking behavior, and plasma concentrations of lipids and lipoproteins. Attention
      was paid to potential modifying factors such as demographic factors (e.g., education,
      socioeconomic status, income, occupation).

      The study completion date listed in this record was obtained from the "End Date" entered in
      the Protocol Registration and Results System (PRS) record.