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Coronary artery disease
Original research
Lifestyle modification in older versus younger patients with coronary artery disease
  1. Patricia Jepma1,2,
  2. Harald T Jorstad1,
  3. Marjolein Snaterse2,
  4. Gerben ter Riet1,2,
  5. Hans Kragten3,
  6. Sangeeta Lachman1,
  7. Madelon Minneboo1,
  8. S Matthijs Boekholdt1,
  9. Ron J Peters1,
  10. Wilma Scholte op Reimer2,3
  1. 1 Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
  2. 2 Achieve Centre for Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
  3. 3 Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
  1. Correspondence to Ms Patricia Jepma, Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; p.jepma{at}amsterdamumc.nl

Abstract

Objective To compare the treatment effect on lifestyle-related risk factors (LRFs) in older (≥65 years) versus younger (<65 years) patients with coronary artery disease (CAD) in The Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists 2 (RESPONSE-2) trial.

Methods The RESPONSE-2 trial was a community-based lifestyle intervention trial (n=824) comparing nurse-coordinated referral with a comprehensive set of three lifestyle interventions (physical activity, weight reduction and/or smoking cessation) to usual care. In the current analysis, our primary outcome was the proportion of patients with improvement at 12 months follow-up (n=711) in ≥1 LRF stratified by age.

Results At baseline, older patients (n=245, mean age 69.2±3.9 years) had more adverse cardiovascular risk profiles and comorbidities than younger patients (n=579, mean age 53.7±6.6 years). There was no significant variation on the treatment effect according to age (p value treatment by age=0.45, OR 1.67, 95% CI 1.22 to 2.31). However, older patients were more likely to achieve ≥5% weight loss (OR old 5.58, 95% CI 2.77 to 11.26 vs OR young 1.57, 95% CI 0.98 to 2.49, p=0.003) and younger patients were more likely to show non-improved LRFs (OR old 0.38, 95% CI 0.22 to 0.67 vs OR young 0.88, 95% CI 0.61 to 1.26, p=0.01).

Conclusion Despite more adverse cardiovascular risk profiles and comorbidities among older patients, nurse-coordinated referral to a community-based lifestyle intervention was at least as successful in improving LRFs in older as in younger patients. Higher age alone should not be a reason to withhold lifestyle interventions in patients with CAD.

  • aged
  • coronary artery disease
  • disease management
  • secondary prevention
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/heartjnl-2019-316056

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    Footnotes

    • Twitter @Patricia_Jepma

    • Contributors PJ had full access to all the study data and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design (of this secondary analysis): PJ, HTJ, MS, GtR, RJP, WSoR. Acquisition of data: PJ, HTJ, MS, GtR. Analysis and interpretation of data: PJ, HTJ, GtR. Drafting of manuscript: PJ, HTJ, GtR. Critical revision of manuscript: MS, JK, SL, MM, SMB, RJP, WSoR. Statistical analysis: PJ, HTJ, GtR.

    • Funding The RESPONSE-2 trial was sponsored by WW International Inc. (formally Weight Watchers International, Inc.) (New York, New York, USA), Philips Consumer Lifestyle (Amsterdam and Eindhoven, The Netherlands) and an anonymous private fund (Amsterdam, The Netherlands). This work was also supported by the Netherlands Organisation for Scientific Research (NWO) (grant number 023.009.036) to PJ.

    • Disclaimer The sponsors had no role in the design, data collection, data analysis, data interpretation and writing of the manuscript.

    • Competing interests SMB has received personal fees from Pfizer. RJP has received personal fees from Sanofi, Boehringer Ingelheim, Amgen and AstraZeneca.

    • Patient and public involvement Patients and/or the public were involved in the design, conduct, reporting or dissemination plans of this research. Refer to the 'Methods' section for further details.

    • Patient consent for publication Not required.

    • Ethics approval The institutional review boards of all recruiting hospitals approved the study.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Requests for analyses of de-identified data from this trial should be directed to: P. Jepma (p.jepma@hva.nl).

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