| Summary: | Cardiovascular disease, especially coronary artery disease, is related to high
morbidity and mortality rates, including in Indonesia. In 2001, the proportion of
cardiovascular deaths in Indonesia was 26.3% and it was the number one cause of death
at that time. Every individual has chances of developing CAD and its complications
(major adverse cardiovascular events or MACE), such as unstable angina, myocardial
infarction and death. There are three different types of managements that can be
entertained to prevent the occurrence and progression of CAD and MACE, namely nonpharmacological,
pharmacological and other managements.
The purpose of this research was to study the effect of a combined lifestyle
modification program of IDE KONSULEN (combination of video presentation,
counseling, distribution of printed materials or brochures and follow-up by phone for a 9
months period) on cardiovascular risk factors and risk of major cardiovascular events in
the subjects with and without CAD.
This research utilized an open randomized controlled method with pre-and posttest
control group design. The CAD subjects were drawn from CAD patients who
attended outpatient visit in Harapan Kita hospital, Jakarta, in the period of September-
October 2011. The non-CAD subjects were drawn from the population without CAD who
resided around Harapan Kita Hospital, Jakarta. At the beginning of the study, 200 CAD
subjects and 200 non-CAD subjects had been recruited. Using simple random method
with computer number, the subjects were allocated into intervention and non-intervention
groups. The subjects in the intervention group were given a lifestyle modification
program that consisted of video presentation, individual counseling with a general
practitioner, distribution of printed materials (brochures) and telephone follow-up 2 times
in a period of 9 months. The subjects in the non-intervention group were not given a
lifestyle modification program.
The primary outcomes measured were the risk of major cardiovascular events,
which was estimated with the Framingham Heart Study score (for CAD subjects) and
ACTION score (for non-CAD subjects). In addition, secondary outcomes were also
measured, namely the mean/median values of risk factors (blood pressure, cholesterol,
blood sugar, BMI) before and after the program.
The results of this research indicated that in the non-CAD subjects, lifestyle
modification program were associated with decreases in systolic blood pressure
(treatment effect was -9.03 mmHg), diastolic blood pressure (treatment effect was -6.00
mmHg), total cholesterol (treatmet effect was -13.60 mg/dl) and BMI (treatment effect
was -0.34 kg/m2). These risk factor improvements were due to improved dietary pattern,
which was evidenced by an improved dietary score (treatment effect was 7.00 points).Improvements of these risk factors led to a reduced risk of major cardiovascular events
evidenced by the reduction of FHS score (treatment effect was -2.15%).
In the CAD subjects, lifestyle modification program was only associated with
decreases in systolic blood pressure (treatment effect was -7.00 mm Hg), diastolic blood
pressure (treatment effect was -0.78 mmHg) and change in QTc interval (treatment effect
was -0.088 seconds). The changes in these risk factors might be caused by an improved
dietary score (treatment effect was 3.00 points). Improvements of these risk factors,
however, did not lead to a decrease in risk of major cardiovascular events.
The conclusion of this research indicated that the lifestyle modification program
of IDE KONSULEN led to improved cardiovascular risk factors in both CAD and non-
CAD subjects. The magnitude of risk factor improvement in the non-CAD subjects was
more noticeable than that in the CAD subjects, and this led to the improved risk of major
cardiovascular events in the non-CAD subjects. Improvements of risk factors in both
CAD and non-CAD subjects were mediated by improved dietary patterns and not by
improvements in physical activity or smoking status.
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