Effectiveness of the ready to reduce risk (3r) complex intervention for the primary prevention of cardiovascular disease

1. The standardized Ready to Reduce Risk (3R) program resulted in improvements to lifestyle among those taking medication for prevention of cardiovascular disease.

2. 3R did not improve medication adherence compared to the control group.

Evidence Rating Level: 2 (Good)

Nearly one-third of deaths across the globe are attributable to cardiovascular disease (CVD), 80% of which are due to premature stroke and heart disease. Primary prevention strategies are important to curb this mortality rate and reduce risk of disease. The Ready to Reduce Risk (3R) intervention was created to respond to multiple risk factors of CVD, particularly improving statin adherence. 3R also includes two group education sessions with follow-up phone support and text messages. This pragmatic, randomized controlled trial aimed to standardize a curriculum for intervention and incorporate an objective biochemical measure of statin adherence. Recruitment and initial data collection occurred between May 2016 and March 2017. Participants were required to be aged 40 to 74 years, have a current statin prescription for at least the past two years for CVD prevention, total cholesterol level ≥5.0 mmol/l, and no pre-existing CVD or inherited lipid disorders or type 1 or type 2 diabetes. A total of 212 participants were randomized, with 120 participants having available urine data and 81 attending the final education sessions and receiving text messages. MMAS-8 data were used to compensate for missing urine values, resulting in a sample size of 206 (M [SD] age = 63.9 [7.2] years, 97% White, 54% female). Baseline statin adherence was 47% for the control group (n = 33) and 62% for the intervention group (n = 40). At 12 months, no differences were discovered between control and intervention groups in medication adherence (adjusted OR 0.91). Diastolic blood pressure was significantly different between groups, such that the intervention group had lower recordings (M difference = -4.28 mmHg, 95% CI -0.98 to -1.58, p = 0.002). Waist circumference also favored the intervention group (M difference = -2.55cm, 95% CI -4.55 to -0.55, p = 0.012). This study also reported that the intervention group demonstrated greater understanding of the condition and control of their treatment. Overall, 3R seems to be a beneficial primary prevention method for populations at risk for CVD but does not improve medication adherence. Thus, further efforts are necessary to improve adherence to medication regimens.

Click to read the study in BMC Medicine

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