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Lifestyle intervention advice for patients with cardiovascular risk factors appears limited

Lifestyle intervention advice from health professionals to patients with hypertension, obesity and hyperlipidaemia appears to be limited

The provision of lifestyle intervention advice from health professionals to patients with the cardiovascular risk factors, hypertension, obesity and hyperlipidaemia, appears, at least from an analysis of electronic medical records, to be limited. This was according to research by a team from the Heidelberg Institute of Global Health, Heidelberg University and University Hospital, Heidelberg, Germany.

The World Health Organization (WHO) has estimated that cardiovascular diseases are the leading cause of death globally, taking an estimated 17.9 million lives each year. Moreover, WHO identifies that the most important behavioural risk factors for cardiovascular disease are an unhealthy diet, lack of physical activity and the use of alcohol and tobacco. In a 2020 statement released by the US Preventive Services Task Force, it was concluded there was moderate certainty that behavioural counselling interventions have a moderate net benefit on cardiovascular disease risk in adults at increased risk. In short, lifestyle intervention advice to those with established cardiovascular risk factors such as hypertension, obesity and hyperlipidaemia was of value. In England, NICE has advocated lifestyle intervention advice to those with hypertension, for lipid modification and for patients with obesity.

Given the recommendations for lifestyle advice for those with established cardiovascular risk factors, for the present study, the UK team wanted to examine to extent to which such advice was given to patients newly diagnosed with hypertension, hyperlipidaemia or obesity. They performed a retrospective analysis of information held in the Clinical Practice Research Datalink Aurum which provides ongoing and anonymised patient data from a representative sample of general practices. The researchers included patients with an initial diagnosis of hypertension, hyperlipidaemia or obesity. They set the primary outcome of interest as the presence of any record record of signposting to, performance of or referral to a lifestyle intervention, appropriate for each condition, before and after the patient’s initial diagnosis. The team included a 12 month period before to 12 months after each diagnosis, i.e., a two-year timeframe.

Lifestyle intervention recording in the medical records

A total of 770,711 patients were included in the analysis; 403129 with hypertension and a median age of 57 years (55.7% male); 104,900 with hyperlipidaemia with median age 55 years (50.2% male) and 261,682 with obesity and median age 48 years (42.8% male).

Among newly diagnosed hypertensive patients, only 55.6% (95% CI 54.9 – 56.4%) were recorded as having lifestyle support within the two-year timeframe. This figure was reduced to 45.2% (95% CI 43.8 – 46.6%) for those with hyperlipidaemia but slightly higher for patients with obesity at 52.6% (95% CI 51.1 – 54.1%).

Interestingly, for 12.2% of those diagnosed with hypertension, 32.2% of patients with hyperlipidaemia and 43.9% of those with obesity, there was no recorded evidence of either medication or lifestyle advice.

Based on these findings, the authors concluded that lifestyle interventions to reduce cardiovascular risk are being under-utilised in primary care in England. They did, however, recognise a limitation of the study in that intervention advice could have been discussed but not recorded and suggested that improvements in formal documentation of any intervention advice are needed.

Lemp JM et al. Use of lifestyle interventions in primary care for individuals with newly diagnosed hypertension, hyperlipidaemia or obesity: a retrospective cohort study JR Soc Med 2022

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