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(Circulation. 2005;111:1298-1304.)
© 2005 American Heart Association, Inc.

Preventive Cardiology

Impact of a Community-Based Multiple Risk Factor Intervention on Cardiovascular Risk in Black Families With a History of Premature Coronary Disease

Diane M. Becker, ScD, MPH; Lisa R. Yanek, MPH; Wallace R. Johnson, Jr, MD; Diane Garrett; Taryn F. Moy, MS; Stasia Stott Reynolds, MD; Roger S. Blumenthal, MD; Dhananjay Vaidya, MD, PhD; Lewis C. Becker, MD

From the Divisions of General Internal Medicine (D.M.B., L.R.Y., D.G., T.F.M., S.S.R.) and Cardiology (R.S.B., D.V., L.C.B.), the Johns Hopkins Medical Institutions, and the Hypertension Program, University of Maryland School of Medicine (W.R.J.), Baltimore, Md.

Correspondence to Dr Diane Becker, Division of General Internal Medicine, Johns Hopkins Medical Institutions, 1830 E Monument St, Room 8028, Baltimore, MD 21287. E-mail dbecker{at}jhmi.edu

Received October 1, 2004; revision received January 3, 2005; accepted January 11, 2005.

Background— Black subjects with a family history of premature coronary heart disease (CHD) have a marked excess risk, yet barriers prevent effective risk reduction. We tested a community-based multiple risk factor intervention (community-based care [CBC]) and compared it with "enhanced" primary care (EPC) to reduce CHD risk in high-risk black families.

Methods and Results— Black 30- to 59-year-old siblings of a proband with CHD aged <60 years were randomized for care of BP 140/90 mm Hg, LDL cholesterol 3.37 mmol/L, or current smoking to EPC (n=168) or CBC (n=196) and monitored for 1 year. EPC and CBC were designed to eliminate barriers to care. The CBC group received care by a nurse practitioner and a community health worker in a community setting. The CBC group was 2 times more likely to achieve goal levels of LDL cholesterol and blood pressure compared with the EPC group (95% CI, 1.11 to 4.20 and 1.39 to 3.88, respectively) with adjustment for baseline levels of age, sex, education, and baseline use of medications. The CBC group demonstrated a significant reduction in global CHD risk, whereas no reduction was seen in the EPC group (P<0.0001).

Conclusions— Eliminating known barriers may not be sufficient to reduce CHD risk in primary care settings. An alternative community care model that addresses barriers may be a more effective way to ameliorate CHD risk in high-risk black families.

Key Words: risk factors • cholesterol • hypertension • trials • prevention

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