Coronary risk reduction intervention for siblings and offspring of patients with premature coronary heart disease : the criso project

Abstract

Background: Preventive cardiology programmes often have limited success, with high-risk individuals maintaining suboptimal health practices. No existing programme on the island targets first-degree relatives of patients with premature coronary heart disease. This project aimed to develop and assess the feasibility, acceptability, and potential effectiveness of a preventive intervention. Design: A 12-month, single-centre RCT with 89 participants, randomly assigned to control (n=45) or intervention (n=44) groups. The intervention, delivered at the general hospital, included risk communication via an online calculator, motivational interviewing-style counselling, and 12 weekly goal-reinforcement calls. Controls received verbal lifestyle advice. Risk factors were assessed at baseline, 6, and 12 months. Feasibility was measured through recruitment/retention; acceptability via questionnaires and interviews with 24 intervention participants. Results: At 6 months, both groups showed significant improvements in diet, physical activity, blood pressure, and health literacy (p < 0.05). However, only the intervention group showed significant improvements in cholesterol, HbA1c, BMI, Heart-Age, and MI risk. At 12 months, both groups maintained improved outcomes in diet, physical activity, and blood pressure, with the intervention group also showing sustained improvements in waist circumference and cholesterol ratio. Between-group differences were non-significant (p > 0.05). Predictors of overweight, obesity, central obesity, and clustering of risk factors included underactivity and sedentarism (p < 0.05). Elevations in systolic (rs = 0.497, p = 0.001) and diastolic blood pressure (rs = 0.453, p = 0.002), Total-C ratio (rs = 0.532, p = 0.001), HbA1c (rs = 0.528, p = 0.001), Heart-Age (rs = 0.566, p = 0.001), and 10-year MI risk (rs = 0.604, p = 0.007) positively correlated with higher BMI. Reductions in waist circumference correlated with lower systolic blood pressure (p = 0.009), while weight changes improved HDL-C (p = 0.006). Systolic blood pressure and Total-C ratio were linked to better Heart-Age scores (p < 0.001) and lower 10-year MI risk (p = 0.006). Quality patient-clinician interactions included personalized feedback and free services. Key intervention components for behaviour change included clinician-guided results discussions, goal setting, reinforcement, and monitoring. Motivators for risk reduction included family history, ageing, and better outcomes, while challenges involved self-discipline, anxiety, addiction, and planning difficulties. Overcoming these challenges required awareness of benefits, simple enjoyable plans, a step-by-step approach, and goal prioritization. Conclusion: While between-group differences were non-significant, understanding motivators and clinician support is vital for behaviour change. Sustainable strategies focusing on patient-specific interventions are needed for improving preventive cardiology outcomes.