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The worldwide burden of cardiovascular diseases remains considerable. Atherosclerotic disease is the long-term consequence of both modifiable (eg, behavioural, environmental) and non-modifiable risk factors, including genetic determinants. Lifestyle modification, such as stopping smoking, increasing physical activity or changes in diet, can result in decreased cardiovascular risk, but lifetime habits are hard to change. Improving lifestyle in people at risk therefore represents one of the major challenges of primary prevention.
Silarova et al have set up the pragmatic and well-designed Information and Risk Modification (INFORM) trial to determine the potentially incremental efficacy of several methods to inform healthy middle-aged and older adults on their cardiovascular risk.1 They included a population of ~1000 blood donors, without known cardiovascular disease, and tested the impact of three different counselling methods, compared with no information on cardiovascular risk factors and prevention of cardiovascular disease. All three intervention groups were offered web-based lifestyle advice; one group additionally received information on their 10-year cardiovascular risk based on their phenotypic characteristics, while the last group received information on their 10-year risk based both on their phenotypic and genetic characteristics. Behavioural outcomes were assessed after 3 months, the primary outcome being physical activity as objectively recorded on 3 consecutive days. An important component of the trial was the assessment of the possible psychological impact of pointing out the individual cardiovascular risk (whether assessed from phenotypic or genetic determinants) of the participants.
The authors should be commended for designing the trial with an open mind, accepting (1) that the value of individual counselling on cardiovascular risk should not be taken for granted and (2) that this personalised information might have an untoward impact on the participants’ psychological state. At first sight, the results of the trial may appear …
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