The effectiveness of lifestyle interventions within secondary prevention of cardiovascular system disease (CHD) remains unclear. cardiac occasions (5 of 9 tests; general RR 0.68 (95% CI 0.55 0.84 The heterogeneity between trials and poor quality of trials help to make any concrete conclusions difficult generally. However the helpful effects seen in this review are motivating and should stimulate further research. 1 WHI-P97 Introduction The World Health Organisation has stated that since 1990 more people worldwide have died from coronary heart disease (CHD) than any other cause [1]. Further they reported that 80% to 90% Rabbit Polyclonal to LDOC1L. of people dying from CHD had one or more major risk factors associated with way of life. In the UK more than 90 0 deaths per year are due to CHD and although death rates are falling they are still among the highest in western Europe [2]. Cardiac rehabilitation (CR) programmes were initiated in the 1960s when the benefits of mobilisation and physical activity (PA) following lengthy hospital stays for CHD became known [3]. Since then secondary prevention has become an essential aspect of care of the patient with CHD [4]. Research has shown that lifestyle change including PA a healthy diet and smoking cessation alters the course of CHD [5-7] and so disease prevention measures have been designed to focus on a range of lifestyle factors. Indeed cardiac rehabilitation and secondary prevention programmes have developed from focusing on exercise alone to becoming multidisciplinary and encompassing baseline patient assessments nutritional counselling risk factor management (i.e. lipids hypertension weight diabetes and smoking) psychosocial and vocational counselling and PA guidance and exercise training in addition to the appropriate use of cardioprotective drugs [4]. Multidisciplinary steps are advocated by governments around the world and in the UK the National Institute for Clinical Excellence (NICE) set out a series of guidelines in 2007 for care of patients who had had a myocardial infarction (MI) [8]. The guidelines covered secondary prevention in primary and secondary care and were not focused solely on lifestyle interventions. They did however incorporate PA diet smoking and drug therapy and were based on systematic reviews of the best available evidence. Priority recommendations considered to have the most important effect on patient care and outcomes included that on discharge from hospital every MI individual should have experienced a confirmed diagnosis of acute MI results of investigations future management plans and guidance on secondary prevention. Also Good highlighted the importance of advice being given regarding regular PA in the form of 20-30 moments of exercise per day to the point of slight breathlessness. Patients should also be advised to stop smoking eat a Mediterranean style diet rich in fibre fruit vegetables and fish and follow a treatment regime with a combination of ACE (angiotensin-converting enzyme) inhibitors aspirin beta-blockers and statins. However despite the evidence that positive lifestyle changes produce improved outcomes results from a number of secondary prevention initiatives have been disappointing. In a systematic review of multidisciplinary secondary prevention programmes McAlister et al. [9] reported that although WHI-P97 some beneficial impact was achieved on processes of WHI-P97 care morbidity and mortality questions remained regarding the duration and frequency of interventions and the best combination of disciplines within an intervention. The EUROASPIRE (European Action on Secondary and Primary Prevention by Intervention to Reduce Events) surveys by the European Society of Cardiology have shown that this adoption of cardiovascular disease prevention measures as part of daily clinical practice was wholly inadequate [10] and that unhealthy lifestyle styles are continuing. The authors commented on the difficulty experienced by adults in changing behaviour despite using a life threatening disease and that continued professional support was imperative if this was WHI-P97 to be achieved. Few previous WHI-P97 reviews of secondary prevention interventions have been published. McAlister et al. [9] carried out a systematic review of RCTs of secondary.