Letters
General medicine
Volume 198 - Issue 8

A cluster randomised controlled trial of vascular risk factor management in general practice

Authors:  James A Dunbar, Edward D Janus and Erkki Vartiainen

Med J Aust 2013; 198 (8): 413-414. || doi: 10.5694/mja12.11601
Published online: 20 May 2013
To the Editor: Harris and colleagues report failure to obtain reduction in several important risk factor-based intermediate outcomes for vascular disease from their lifestyle intervention in the Health Improvement and Prevention Study (HIPS).1 Using intention-to-treat analysis, if only 117 of 384 participants completed at least two of six group sessions, a positive result could not be expected. We know that interventions for prevention of cardiovascular disease (CVD) ...
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To the Editor: Harris and colleagues report failure to obtain reduction in several important risk factor-based intermediate outcomes for vascular disease from their lifestyle intervention in the Health Improvement and Prevention Study (HIPS).1 Using intention-to-treat analysis, if only 117 of 384 participants completed at least two of six group sessions, a positive result could not be expected. We know that interventions for prevention of cardiovascular disease (CVD) and diabetes can be run successfully in Australian primary care, which raises questions about the design of Harris et al’s intervention.

In 2007, the Council of Australian Governments identified an effective Australian primary care-based diabetes and CVD risk prevention program — the Greater Green Triangle Diabetes Prevention Program2 — which has been shown to change dietary behaviour via an effective theoretical model.3

The Counterweight program used in Harris et al’s intervention — which is based on the obsolete Transtheoretical (Stages of Change) Model (TTM)4 — was aimed at weight reduction, not CVD risk. The measures included fruit and vegetable consumption, not CVD-specific measures such as saturated : polyunsaturated fat ratio and salt intake. The effect of dietary changes could not be measured, so feedback on this could not be provided to participants, which further weakens the intervention.

The aims of the intervention, training, methods of empowerment and tools are unclear. If the training was based on TTM, this might explain the negative results, particularly in light of a number of trials which have shown that TTM does not work or explain behavioural changes.

Further trials are not needed because full-scale implementation of an intervention based on the Greater Green Triangle Diabetes Prevention Program — the Department of Health-funded program Life! Helping You Prevent Diabetes, Heart Disease and Stroke — has already occurred in Victoria.5 General practitioners should not lose confidence in lifestyle modification for prevention of CVD and diabetes.

Authors

  • James A Dunbar1
  • Edward D Janus1,2
  • Erkki Vartiainen1,3
  • 1. Greater Green Triangle — University Department of Rural Health, Flinders University and Deakin University, Warrnambool, VIC.
  • 2. Department of Medicine, University of Melbourne, Western Hospital, Melbourne, VIC.
  • 3. Division of Welfare and Health Promotion, National Institute for Health and Welfare, Helsinki, Finland.

Correspondence: director@greaterhealth.org

Competing interests

No relevant disclosures.

References

View this article on Wiley Online Library

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