Family risk of developing heart disease can be reduced by lifestyle advice and regular health checks

A study of 750 families in shows that a program encouraging whole families to live a healthier lifestyle could reduce the risk of coronary disease.

An individual with a family history of early heart disease (diagnosed before 55 years) is at 1.5-7 times greater risk for future cardiovascular diseases. The study was published in The Lancet in Oct 2022. It was conducted in from January 2015 through April 2017. The study involved 368 families receiving regular check-ups once every two months. They also encouraged them to exercise more, change their diet, quit smoking, and connect them to a primary care center. The 382 families that received ‘usual’ care, which is one-time counseling and an annual screening, were compared.

Research has shown that family members are more likely to be motivated to change their lifestyles than to continue to provide care. The study found that families operate within the context of their biological and cultural relationships. This means that it is more effective to encourage the whole family to make lifestyle changes. It was also stated that family relationships could help improve the well-being of family members who are dealing with other chronic diseases.

According to the Global Burden of Disease Study 2022, the number of cases of cardiovascular disease in the world has nearly doubled, from 271 million people in 1990 to 523 million in 2019. More than 2.5 million Indians died from cardiovascular disease in 2022, accounting for 13.5% of global deaths due to heart disease.

Are more likely to develop heart disease. The rate of cardiovascular disease is twice that of the west. The study found that it occurs 10-12 years earlier for people of Indian descent than those living in high-income nations. Extreme financial distress can also be caused by heart disease, particularly in countries with low or middle incomes.

It is important to adopt a family-based approach because excess heart disease risk from family history is not due to genetics. However, the study found that “substantial evidence” supports the idea that the extra risk is due to shared environments, similar behaviors, and beliefs within families. A reduction in cardiovascular risk in India is possible when families adopt healthy behavior. This could positively impact public health and help save years of productive life.

In other South Asian countries, the family-based model has also proven effective. Another February 2022 in Pakistan,  and found that a similar model, which involved home visits by government community health workers, had a lower blood pressure than usual.

The intervention

Over two years, non-physician healthcare workers such as ASHAs and nurses made 13 visits to each family. They measured blood pressure and glucose and asked families to keep a health diary. Family members were encouraged to eat four to five servings of seasonal and locally grown fruits and vegetables per day. They also advised them to reduce their salt intake to one-quarter teaspoon per person per day, consume less sugar than two tablespoons per day, and increase their daily walking time (mostly walking) from 30-60 minutes. Healthcare workers advised families to avoid alcohol and tobacco products.

Health workers received 2.5-day training to counsel families and use devices to measure blood sugar and blood pressure. They were paid Rs 250 per visit to cover travel and other expenses.

The families were asked to return to the hospital twice during the first year and again at the end to monitor their health. Researchers looked at four outcomes. Blood pressure less than 140/90mm Hg (millimetres mercury); fasting glucose less than 110 mg/dL (mg/dL); low density lipoprotein (the blood cholesterol level–less than 100 mg/dL); and abstinence from tobacco or smoking. Except for the person with heart disease, the entire family should have achieved or maintained any of these outcomes at every check-up.

(a cardiologist at PHI) and one of the paper’s authors stated that very few studies examine lifestyle changes in a family environment.

The results

Sixty-four percent of 807 participants in the family-based care group had achieved three of the four outcomes by the end of the second. 74% of those who received family-based care had achieved the required blood pressure by the end of the second. The authors also calculated the average Framingham risk score. These are estimates of the risk of heart disease over 10 years. This was lower than the 11.4% to 8.1% for the family-based care group and a decrease of 12.2 to 11.4% for the usual care group.

According to the study, the odds of attaining at least three outcomes were two times greater in the family-based group than in those who received usual care.

The study found that all those who received family-based treatment had lower cardiovascular risk, regardless of sex and age. This suggests that all family members are affected equally by changes to make healthier choices.

The study did not include the ripple effect, which refers to the effects on people who are not directly involved in the research but may have been exposed to it.

Wellness and health centers could be a catalyst for program scale-up

Although the study proved that family-based programs could reduce heart disease risk, it was conducted in a highly educated population who had previously visited a hospital.  also explained that the research was conducted at one healthcare center, including families with similar socioeconomic backgrounds. “The study was conducted in Kerala, where there is high health literacy and innovation. said the study should be applied in other states with low literacy.

Each family was charged Rs 3500 (47.4) for the program. It also requires healthcare workers to be trained to perform regular checks and offer advice on exercise and diet changes to families. If the program is to be scaled up, it will also need a system that ensures that healthcare workers are properly trained and regularly contact families. stated that although some quality checks have been built into the program, it is possible to create a program where evaluation can be concurrent.

Said that while the government of has set up wellness and health clinics with non-physician providers who would engage with the community, this makes it possible to implement the “large scale” approach. According to a press release issued by the health ministry in April 2022, more than 75,000 of these centers have been operationalized, and the government plans to double them by December 2022. The study indicated that expanding this study approach to health and well being centers could reduce the annual monitoring cost per family.

Stated that the community health worker is key to the program’s success. He also said that healthcare workers could be trained in large numbers. stated that more research is needed to determine if this approach can be implemented on a larger scale and if it can be sustained. Also how to integrate it into India’s healthcare system.

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