Concordance for cardiovascular risk changes within families of patients with coronary disease participating in a preventive cardiology programme

Abstract

Aims: To investigate concordance for lifestyle – smoking, diet and physical activity - between married couples when one has developed coronary disease, and concordance for lifestyle change over one year in a nurse-led, multidisciplinary, family centred, prevention programme across six countries. Methods: In the EUROACTION trial consecutive coronary patients were recruited from hospitals, with their partners, to this programme. Concordance for smoking, diet and physical activity, and cardiovascular risk factors, was investigated at the initial assessment, at 16 weeks and one year. Findings: 645 couples attended the initial assessment and 65% of couples returned at one year. At the time of the coronary event, there were nearly two times as many couples, than expected by chance, currently smoking. Couples were also concordant at baseline for saturated fat (r=0.41) fruit and vegetables (r=0.67) and for physical activity (r=0.25). With the exception of total cholesterol, cardiovascular risk factors in couples were all significantly correlated: body mass index (BMI) r=0.22; waist circumference (WC) r=0.12; systolic blood pressure (SBP) r=0.20; total cholesterol (TC) r=0.07; LDL-C r=0.13; HDL-C r=0.27 and fasting blood glucose (FBG) r=0.20 reflecting concordance for lifestyle. The smoking quit rate at one year was significantly higher at 74% in patients with a partner who was a non-smoker compared to 50% in patients with a partner who smoked (p=0.03). There was significant concordance for change at one year between patients and partners for: saturated fat r=0.43; fruit and vegetables r=0.61; physical activity r=0.40; BMI r=0.21; WC r=0.22; SBP r=0.13; TC r=0.21 and HDL-C r=0.34. Patients making the healthiest lifestyle changes were associated with partners making similarly healthy changes. Interpretation: Couples had an unhealthy concordant lifestyle at baseline but became healthier during the course of the preventive cardiology programme, with concordance for change between couples at both 16 weeks and one year. As couples are concordant for lifestyle, with observational evidence of concordance for change, we should focus on couples rather than patients alone.