Abstract 16489: Cardiovascular Disease Risk Reduction in Socioeconomically Austere Rural Environments: A Randomized, Controlled Efficacy Trial of a Self-Care Intervention Followed by an Effectiveness Study
Background: Cardiovascular disease (CVD) risk is extraordinarily high in austere, rural environments in Kentucky. Although this risk is increasing and affects millions, no interventions focusing on reduction of multiple CVD risk factors have been tested in this area.
Purpose: To determine, in a 2 phase study, the impact of a self-care CV risk reduction intervention targeting multiple CV risk factors on lipid profile, blood pressure, body mass index (BMI), and activity levels among adults living in austere rural environments.
Methods: Phase was 1 a randomized, controlled efficacy trial in which 425 adults (76% women; mean age 58±16 yrs) with 2 or more CVD risk factors were enrolled and randomized to either immediate intervention or wait-list control groups. The intervention was a 12-week self-care CVD risk reduction program, focused on reducing environmental and personal barriers to CVD risk reduction. Phase 2 was an effectiveness trial using community participatory principles and designed to be sustained post-study. A total of 752 adults (74% women; mean age 50±13yrs) from 4 sites across Kentucky were enrolled in the same intervention and followed for 6 months post-intervention.
Results: In Phase 1, the following changes were significant from pre-intervention to post-intervention: 1) low density lipoprotein decreased from 110.5 ± 34.5 mg/dL to 95.8 ± 32.6 mg/dL (p = 0.01); 2) high density lipoprotein increased in men from 34.5 ± 13.2 mg/dL to 39.8 ± 12.9 mg/dL (p = 0.03) and in women, from 49.6 ± 15.1 mg/dL to a post level of 55.7 ± 15.0 (p < 0.001); 3) total cholesterol decreased from 190 ± 38 mg/dL to 180 ± 36 mg/dL (p < 0.001); 4) pre-intervention, 21% of participants engaged in moderate activity for 30 minutes per day at least 4 days a week, while post-intervention 60% did (p < 0.001); 5) body mass index decreased from 32.6 ± 7.7 to 28.4 ± 7.9 (p < 0.001). In Phase 2, this same pattern of 10% or greater significant improvement in risk factors was evident in all outcomes .
Conclusion: Self-care interventions that overcome environmental and personal barriers to CVD risk reduction are effective in rural, austere environments and can be implemented by communities at risk.
- © 2013 by American Heart Association, Inc.