Article Text
Abstract
Objective To evaluate long-term risk of first cardiovascular (CV) events, CV deaths and all-cause deaths in community-dwelling participants of a cardiovascular disease (CVD) prevention programme delivered in a primary care setting.
Methods Individuals who visited a primary healthcare service in Sollentuna (Sweden) and agreed to participate in the programme between 1988 and 1993 were followed. They had at least one CV risk factor but no prior myocardial infarction and received support to increase physical activity using the programme Physical Activity on Prescription and to adopt health-promoting behaviours including cooking classes, weight reduction, smoking cessation and stress management. Participants (n=5761) were compared with a randomly selected, propensity score-matched reference group from the general population in Stockholm County (n=34 556). All individuals were followed in Swedish registers until December 2011.
Results In the intervention group and the reference group there were 698 (12.1%) and 4647 (13.4%) first CV events, 308 (5.3%) and 2261 (6.5%) CV deaths, and 919 (16.5%) and 6405 (18.5%) all-cause deaths, respectively, during a mean follow-up of 22 years. The HR (95% CI) in the intervention group compared with the reference group was 0.88 (0.81 to 0.95) for first CV events, 0.79 (0.70 to 0.89) for CV deaths and 0.83 (0.78 to 0.89) for all-cause deaths.
Conclusions Participation in a CVD prevention programme in primary healthcare focusing on promotion of physical activity and healthy lifestyle was associated with lower risk of CV events (12%), CV deaths (21%) and all-cause deaths (17%) after two decades. Promoting physical activity and healthy living in the primary healthcare setting may prevent CVD.
- cardiovascular
- physical activity
- prevention
- primary care
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Footnotes
Presented at Parts of the results were presented at the European Society of Cardiology Congress 2018, August 25–29, Munich, Germany.
Correction notice This article has been corrected since it published Online First. Footnote symbols ‡ and § have been removed from table 1.
Contributors GJ, NH, GW, IK, PL, UF and M-LH contributed to conception and design. GJ and MV contributed to the analysis. GJ, IK, UF and M-LH contributed to acquisition. GJ drafted the manuscript. All authors critically revised the manuscript, contributed to interpretation, gave final approval and agreed to be accountable for all aspects of the work ensuring integrity and accuracy.
Funding This work was supported by grants from the Swedish Society of Medicine (grant number 407891 and 587111) and the Swedish Heart-Lung Foundation (grant number 20100473, 20130646 and 20150692). The prevention programme was supported by the Stockholm County Council and the Wallenberg Foundation.
Competing interests GJ has received grants from the Swedish Society of Medicine and has received consultancy fee from Amgen, outside the submitted work. NH has been employed at AstraZeneca R&D, Mölndal. PL has received grants from the Swedish Heart and Lung Foundation and is employed at the Swedish Institute for Health Economics, Stockholm. M-LH has received grants from the Swedish Heart and Lung Foundation for the submitted work, and from the Swedish Heart and Lung Foundation, Knut and Alice Wallenberg Foundation, King Gustav V Foundation, Karolinska Institutet Foundation, Stockholm County Council and Skandia Risk Health, outside the submitted work.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Ethics approval The Regional Ethics Review Board in Stockholm approved the study (2012/1172-31/1 and 2013/1329-32).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No data are available. Participant data from the National Board of Health and Welfare in Sweden, Statistics Sweden, and The National Insurance Agency in Sweden were deidentified. The data set delivered from the registers included serial numbers for each participant but no identification number. Protocol and statistical analysis plans are available.