Counseling Could Help Reduce Heart Disease Risk

Behavioral counseling to improve diet and physical activity may help those at risk for cardiovascular disease

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) Patients can reduce some risks for heart disease — like high blood pressure, metabolic conditions and cigarette smoking — through counseling and lifestyle changes, a recent study suggested.

Because of this, some US health experts have recommended that people with certain risk factors for heart disease undergo behavioral counseling programs aimed at improving diet and exercise.

A new study attempted to review such programs' effectiveness and found that, after two years, patients had lower cholesterol rates, lower blood pressure and a reduced diabetes risk.

"Keep healthy foods on hand so they are easy to grab."

The new study — a review conducted for the US Preventive Services Task Force (USPSTF) — was led by Jennifer S. Lin, MD, of Kaiser Permanente Center for Health Research in Portland, OR. The research team aimed to explore how lifestyle counseling might affect those at risk for heart disease.

To do so, Dr. Lin and colleagues searched thousands of studies to identify 74 trials involving lifestyle counseling among those with risk factors related to heart disease.

Most of the trials (49) involved both diet and exercise counseling, while the remainder focused on one area. Most of the programs were considered medium- or high-intensity (48 and 37, respectively). These programs involved multiple sessions over a period of months and included strategies like weight goals, individualized care plans and education.

After analyzing the results of these trials, the study authors found that intensive lifestyle counseling programs seemed to affect patients for the better. 

According to the Mayo Clinic, a total cholesterol level of below 5.2 millimoles per liter (mmol/L) is considered "desirable." Levels between 5.2 and 6.2 mmol/L are considered "borderline high," and cholesterol levels that have increased above 6.2 are considered high. Dr. Lin and colleagues found that one to two years after counseling, total cholesterol levels fell in these patients by an average of 0.12 mmol/L.

Blood pressure was also examined by the study authors. According to the Mayo Clinic, a systolic blood pressure level — the top number in a blood pressure reading - of below 120 millimeters of mercury (mm Hg) is considered normal, and levels between 120 and 139 are considered "prehypertension" — or "pre-high blood pressure." If levels continue to increase to 140 or above, high blood pressure is at play. Dr. Lin and team found that systolic blood pressure fell by an average of 2.03 mm Hg.

For diastolic blood pressure - the bottom number in a blood pressure reading — a level of below 80 mm Hg is considered normal, and levels between 80 and 89 are considered pre-high blood pressure. If levels increase to 90 or above, this blood pressure measurement is considered high. The study authors found that counseling participants' diastolic blood pressure fell by an average of 1.38 mm Hg. 

The researchers noted that the changes seen in factors like cholesterol and blood pressure were small, but previous evidence suggested that even slight boosts in these factors may reduce the risk for heart troubles.

Based on this review by Dr. Lin and colleagues, the USPSTF released updated guidelines recommending that overweight or obese adults with risk factors for heart disease be referred to behavioral counseling that promotes a healthy diet and exercise.

The study by Dr. Lin and team was a large overview of many different programs with different strategies and parameters. Further research is needed to better understand what sort of lifestyle programs may be most effective at reducing the risk for heart disease.

The study was published Aug. 25 in the Annals of Internal Medicine.

The Agency for Healthcare Research and Quality (AHRQ) funded the study. A number of the study authors reported other ties — including receiving grants and contracts for work — to both the AHRQ and the USPSTF.

Review Date: 
August 21, 2014
Last Updated:
August 26, 2014