Wayne State University

Wayne State University study shows combined behavioral interventions best way to reduce heart disease risk

Detroit — A study led by a Wayne State University researcher shows that combining counseling, extended follow-up with a health care provider, and self-monitoring of diet and exercise is the most effective way to help patients embrace lifestyle changes that can lower their risk for heart and blood vessel (cardiovascular) diseases.

The study published today in Circulation: Journal of the American Heart Association states that current health care policies should be modified to encourage these interventions.

Cardiovascular disease (CVD) is the leading cause of death in the United States. According to American Heart Association statistics, about 81.1 million adults, or one out of every three people in America, have at least one type of CVD. Also, if cardiovascular diseases were completely eradicated, life expectancy could increase by nearly seven years.

“We need to do a better job finding ways to help people not only change their behaviors but maintain them over a lifetime,” said Nancy T. Artinian, Ph.D., R.N., professor, associate dean for research and director of the Center for Health Research at Wayne State University’s College of Nursing.

“As health care providers, we’re pretty good at saying that you are at risk for a disease, you need to lose weight, be more physically active, and eat more fruits and vegetables. While that’s easy to say, it’s not easy for the person to actually translate it into their everyday life,” added Artinian.

After an extensive examination of peer-reviewed scientific studies, Artinian and her co-authors identified several critical parts of effective behavioral change programs, including health care providers using a motivational interviewing technique to encourage patients to make healthier lifestyle choices, counseling patients that occasional setbacks are normal and scheduling recurring follow-up sessions with patients.

The most effective patient-controlled behaviors include setting specific goals for physical activity and dietary improvements and keeping track of progress toward their goals, Artinian said.

Artinian and her co-authors analyzed 74 studies conducted among U.S. adults between January 1997 and May 2007. The studies measured the effects of behavioral change on blood pressure and cholesterol levels; physical activity and aerobic fitness; and diet, including reduced calorie, fat, cholesterol and salt intake, and increased fruit, vegetable and fiber consumption.

“Many people face psychological and cultural challenges when faced with the need to make changes in their daily health habits. This statement shows us what types of programs work – now we need to find ways to make effective lifestyle change programs available to the groups of people at highest risk for cardiovascular diseases – older Americans, African Americans and people of Hispanic origin,” said Ralph Sacco, M.D, president of the American Heart Association.

Although obesity, physical inactivity and poor diet are well recognized as major risk factors for cardiovascular disease, it’s often difficult for doctors and nurses to help patients reduce their risk for an extended period. They encounter numerous obstacles, including time constraints, reimbursement problems and insufficient training in behavioral-change techniques, the authors write.

Despite these difficulties, Artinian said policy changes will eventually make critical interventions more readily available.

Federal health reform legislation includes provisions that would improve access to preventive services and help Americans make healthier food choices to control risk factors for heart disease and stroke. For example, the new law requires calorie information on restaurant menus and vending machines and eliminates co-pays for certain preventive services under Medicare and new private health plans. The legislation also includes funding to support public health interventions at the state and local levels aimed at lowering risk factors for chronic disease.

“I’m looking forward to the future when we will have a health care system that gives more weight to the importance of prevention and changing lifestyle behaviors to help people stay healthy and reduce cardiovascular risk,” Artinian said.

Co-authors are: Gerald Fletcher, M.D., co-chair; Dariush Mozaffarian, M.D., Dr.PH.; Penny Kris-Etherton, Ph.D., R.D.; Linda Van Horn, Ph.D., R.D.; Alice H. Lichtenstein, D.Sc.; Shiriki Kumanyika, Ph.D., M.P.H.; William E. Kraus, M.D.; Jerome L. Fleg, M.D.; Nancy S. Redeker, Ph.D., R.N.; Janet C. Meininger, Ph.D., R.N.; Joanne Banks, R.N., Ph.D.; Eileen M. Stuart-Shor, Ph.D.; Barbara J. Fletcher, R.N., M.N.; Todd D. Miller, M.D.; Suzanne Hughes, M.S.N., R.N.; Lynne T. Braun, Ph.D.; Laurie A. Kopin, M.S., R.N.; Kathy Berra, M.S.N.; Laura L. Hayman, Ph.D., R.N.; Linda J. Ewing, Ph.D., R.N; Philip A. Ades, M.D.; J. Larry Durstine, Ph.D.; Nancy Houston-Miller, B.S.N.; and Lora E. Burke, Ph.D., M.P.H., steering committee co-chair.


Wayne State University is one of the nation’s pre-eminent public research universities in an urban setting. Through its multidisciplinary approach to research and education, and its ongoing collaboration with government, industry and other institutions, the university seeks to enhance economic growth and improve the quality of life in the city of Detroit, state of Michigan and throughout the world. For more information about research at Wayne State University, visit http://www.research.wayne.edu

Wayne State University’s College of Nursing is internationally recognized for preparing students to become nurse leaders, scholars and researchers. The college was the first to create a Center for Health Research to advance nursing research. For more information, visit http://www.nursing.wayne.edu/