Randomized trial of cardiovascular prevention in Norway combining an in-hospital lifestyle course with primary care follow-up: the Hjerteløftet study

Hilde Bergum; Irene Sandven; Michael Abdelnoor; Sigmund Alfred Anderssen; Jostein Grimsmo; Dag Elle Rivrud; Nils Erling Myhr; Mona Bekken Vold; Cesilie Stenbakken; Bengt Lidfors; Laila Dufseth; Tor Ole Klemsdal

doi:10.1093/eurjpc/zwac211

Randomized trial of cardiovascular prevention in Norway combining an in-hospital lifestyle course with primary care follow-up: the Hjerteløftet study

Eur J Prev Cardiol. 2022 Dec 7;29(17):2252-2263. doi: 10.1093/eurjpc/zwac211.

Affiliations

¹ Department of rehabilitation and lifestyle medicine, LHL-Hospital Gardermoen, Postboks 103 Jessheimbyen, 2051 Jessheim, Norway.
² University of Oslo, Postboks 1078 Blindern, 0316 Oslo, Norway.
³ Oslo Center for Biostatistics and Epidemiology (OCBE), Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway.
⁴ Epidemiology and Biological Statistics, Independent Health Research Unit, Nobels gate 5, 0273 Oslo, Norway.
⁵ Department of Sports Medicine, the Norwegian School of Sports Sciences, Sognsveien 220, 0806 Oslo, Norway.
⁶ Department of Preventive Cardiology, Oslo University Hospital, Aker, Trondheimsveien 235, 0586 Oslo, Norway.

PMID: 36124709
DOI: 10.1093/eurjpc/zwac211

Abstract

Aims: Cardiovascular risk factor control is suboptimal in Europe, including Norway. The present study examined the efficacy of a multimodal primary prevention intervention programme based on the existing Norwegian health care system.

Methods and results: In this open-label randomized controlled trial, adult patients with elevated cardiovascular risk were randomly assigned to an intervention programme including a hospital-based lifestyle course and primary care follow-up or to a control group (CG). The participants were recruited between 2011 and 2015. Primary outcome was change in validated cardiovascular risk scores, national and international (NORRISK, NORRISK 2, Framingham, PROCAM) between baseline and follow-up. Secondary outcomes included major cardiovascular risk factors. After 36 months the NORRISK score was significantly improved in patients assigned to the intervention group (IG) compared to patients assigned to the CG; absolute difference in mean delta score in the IG (n = 305) compared to mean delta score in the CG (n = 296): -0.92, 95% CI: -1.48 to -0.36, P = 0.001. The results for NORRISK 2, Framingham and PROCAM showed similar significant effects. The secondary endpoints including total cholesterol and blood pressure were only minimally, and non-significantly, reduced in the IG, but the proportion of smokers (P = 0.0028) and with metabolic syndrome (P < 0.0001) were significantly reduced. A limited number of cardiovascular events were observed, IG (n = 9), CG (n = 16).

Conclusion: In subjects with elevated cardiovascular risk, a newly developed prevention programme, combining a hospital-based lifestyle course and primary care follow-up, significantly reduced cardiovascular risk scores after 36 months. This benefit appeared achievable primarily through improvements in metabolic syndrome characteristics and smoking habits.The study protocol was registered in ClinicalTrials.gov (NCT01741428).

Keywords: Cardiovascular disease; Cardiovascular risk; Lifestyle intervention; Metabolic syndrome; Primary prevention; Smoking cessation.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Cardiovascular Diseases* / diagnosis
Cardiovascular Diseases* / epidemiology
Cardiovascular Diseases* / prevention & control
Hospitals
Humans
Metabolic Syndrome*
Norway / epidemiology
Primary Health Care

Associated data

ClinicalTrials.gov/NCT01741428