Reducing Cardiovascular Events and Mortality with Monthly Lifestyle Modification Counseling

Lifestyle modification can impact cardiovascular outcomes including myocardial infarction, strokes, and death. 

Many providers may not have the time to dedicate themselves to counseling patients with diabetes about lifestyle modifications.  However, monthly lifestyle modification should become a necessity to improve the overall outcome in patients with diabetes.     

In previous studies, evidence that lifestyle modifications could help with improving the overall health of a patient were lacking.  Most trials showed that lifestyle modifications reduced blood pressure, weight, and blood glucose levels.  Nevertheless, these are simply numbers, and often patients do not understand their significance. Now, we have a trial that shows lifestyle modification can have an impact on cardiovascular outcomes such as myocardial infarction, strokes, and death.  This helps to put things in perspective for patients.   

In the study, researchers collected electronic notes of patients with hyperglycemia to evaluate a composite outcome of cardiovascular events and death in patients that received frequent counseling in a primary care setting.  Researchers observed medical records at Brigham and Women’s Hospital and Massachusetts General Hospital in Boston between the years 2000 to 2014. They discovered 19,293 adult patients with diabetes. Within this patient population, the average age was 58 years of age, 51% of the population were females, and the average Hemoglobin A1c was 7.8%.  They followed each patient for an average of 5.4 years and recorded cardiovascular events and mortalities of all causes.  

Patients that partook in this trial and participated in at least a once a month counseling session had a 2-year reduction in HbA1c by 1.8%, while others who did not participate had a reduction in HbA1c by 0.8% (P<0.001). Other results included fewer cardiovascular events and death from all causes among patients with regular counseling versus patients that have less than a monthly counseling (33% vs. 38.1% in 10 – year cumulative incidence rate) (P=0.0005).    

A composite outcome measured cardiovascular outcomes and death from all-cause, which had a reduction of 12% in patients with monthly counseling compared to those who had counseling every three months (HR = 0.88; 95% CI, 0.82-0.94). When the researchers separated these outcomes, they saw that cardiovascular events were reduced by 11% (HR = 0.89; 95% CI, 0.82-0.97 and deaths by all causes were reduced by 6% (HR = 0.94; 95% CI, 0.86-1.01) in patients that participated in at less one monthly counseling versus quarterly counseling sessions.    

This study concluded that counseling about lifestyle modifications more frequently can lead to a lower incidence of cardiovascular outcomes and death from all causes.  It is essential to know that these findings do not show what lifestyle modification(s) were made (i.e., improving eating habits, increasing exercise or changing type of exercise, and average weight loss among patients).  Counseling about lifestyle modifications monthly can help patients set achievable goals for themselves to improve glycemic control, eating habits, weight loss, and to reduce cardiovascular outcomes and deaths from all causes.  

Practice Pearls:  

• In this study, monthly counseling about lifestyle modifications was associated with a lower risk of cardiovascular outcomes and death from all causes in patients with diabetes compared to patients who partook in quarterly counseling.  
• At least one monthly counseling session about lifestyle modifications in a primary care setting was associated with lowering HbA1c by 1.8% in patients over two years compared to 0.7% in patients not participating in monthly counseling sessions.   
• Providers should coordinate patient-centered care, where the patient can set achievable goals for themselves.   

H, Zhang. “Monthly Lifestyle Counseling May Reduce Cardiovascular, Mortality Risks for Patients with Diabetes.” Healio, https://www.healio.com/endocrinology/diabetes/news/online/{eb15be30-4b6b-45da-9bd8-1984c7a42731}/monthly-lifestyle-counseling-may-reduce-cardiovascular-mortality-risks-for-patients-with-diabetes?M_BT=2469436429117.  

Zhang, Huabing, et al. “Lifestyle Counseling and Long-Term Clinical Outcomes in Patients with Diabetes.“ Diabetes Care, American Diabetes Association, July 9, 2019, https://care.diabetesjournals.org/content/early/2019/07/05/dc19-0629.  

Keri Hames, PharmD Candidate, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences