A study conducted by the Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST) has demonstrated that targeted family-based interventions can be very effective in reducing the total cardiovascular risk in individuals with a family history of premature coronary heart disease.
The PROLIFIC study done amongst patients with premature coronary heart disease and their families has been published online in the journal of Lancet Global Health.
The study clearly shows that low-cost interventions involving entire families can help patients in adhering to lifestyle changes and drug regimen and effectively reduce their cardiovascular risk, irrespective of their age, sex, and level of baseline risk
The study followed up 1,671 individuals with family history of premature coronary heart disease and obtained data on lifestyle, clinical, and biochemical characteristics at baseline and annually during a two-year period.
The primary outcome was achievement or maintenance of any three of the following: blood pressure lower than 140/90 mm Hg; fasting plasma glucose lower than 110 mg/dL; low-density lipoprotein cholesterol lower than 100 mg/dL and abstinence from tobacco.
The patients in the intervention arm of the trial received a comprehensive package of interventions, which included (a) screening for cardiovascular risk factors, (b) structured lifestyle interventions, (c) linkage to primary health care facility, and (d) active follow-up of intervention adherence. The non-physician health workers such as ASHA workers acted as facilitators of intervention delivery at the family level.
In two years, the interventions yielded a 19% absolute increase in achievement of the composite primary outcome. When 64% of those in the intervention group managed to achieve better control of risk factors, only 46% in the usual care group could do the same.
The interventions were focused on high-risk families who had at least one member affected by premature coronary heart disease. Individuals with a family history of the disease comprise a large group, at least 24% of the total adult population in India.
Every year, 1.5 million deaths due to coronary heart disease are happening in India.
“The total cardiovascular risk reduction achieved in the study might be expected to translate into approximately 20% fewer cardiovascular events and prevent at least 3,00,000 deaths, annually,” Jeemon Panniyammakal, the lead author of the study, said.
The Lancet Global Health, in its editorial, pointed out that considering the escalating burden of cardiovascular diseases in low-income and middle-income countries, the PROLIFIC trial substantially contributes towards the primary and secondary prevention of coronary heart disease.
The study by Dr. Jeemon and colleagues showed that 13 home visits and repeated reminders had a positive effect on adhering to therapy and controlling risk factors such as unhealthy diet, tobacco cessation, home blood pressure monitoring, blood sugar monitoring, and emphasis on daily exercise.
Proactive home visits by trained health workers have the potential to improve cardiovascular health. Training of health workers for better control of risk factors at the family level can prevent the development of clinical disease. If the low-cost intervention in the PROLIFIC trial (USD 47·4 per family, per year) can be incorporated into primary care, it can not only result in huge savings but be more more effective than standard care for cardiovascular diseases, the editorial commented.
