Reduced Cardiovascular Disease Incidence With a National Lifestyle Change Program

• Type of Material: Article
• Authors: Sandra L. Jackson, Atlanta VA Medical Center; Sandra E Safo, Emory University; Lisa R Staimez, Emory University; Qi Long, Emory University; Mary Rhee, Emory University; Solveig A. Cunningham, Emory University; Darin Olson, Emory University; Anne Tomolo, Emory University; Usha Ramakrishnan, Emory University; K.M. Venkat Narayan, Emory University; Lawrence S Phillips, Emory University
• Language: English
• Date: 2017-04-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine
• Final Published Version (URL): http://dx.doi.org/10.1016/j.amepre.2016.10.013
• Title of Journal or Parent Work: American Journal of Preventive Medicine
• ISSN: 0749-3797
• Volume: 52
• Issue: 4
• Start Page: 459
• End Page: 468
• Grant/Funding Information: This work was supported in part by U.S. Food and Drug Administration award RO1FD003527 (LSP), VA award HSR&D IIR 07-138 (LSP and SLJ), NIH awards R21DK099716 (LSP, QL, LS, and SLJ), DK066204 (LSP), U01 DK091958 (LSP and MKR), U01 DK098246 (LSP and DEO), R21NS091630 (QL), K12 award 5K12HD085850 (SS), PCORI award ME-1303-5840 (SS and QL), and a Cystic Fibrosis Foundation award PHILLI12A0 (LSP).; It is also supported in part by the National Center for Advancing Translational Sciences of NIH under award number UL1TR000454.; Drs. Phillips, Rhee, Olson, and Tomolo receive support from the VA, and Dr. Jackson conducted analyses using VA resources and data.
• Keywords: DIET; Medicine, General & Internal; WEIGHT-MANAGEMENT PROGRAM; IMPAIRED GLUCOSE-TOLERANCE; VETERANS; General & Internal Medicine; INTERVENTIONS; DIABETES PREVENTION; Life Sciences & Biomedicine; OBESITY; OUTPATIENT CARE; CORONARY-HEART-DISEASE; Science & Technology; MORTALITY; Public, Environmental & Occupational Health
• Research Categories: Health Sciences, Public Health; Biology, Bioinformatics; Biology, Biostatistics

Abstract

Introduction Lifestyle change programs implemented within healthcare systems could reach many Americans, but their impact on cardiovascular disease (CVD) remains unclear. The MOVE! program is the largest lifestyle change program implemented in a healthcare setting in the U.S. This study aimed to determine whether MOVE! participation was associated with reduced CVD incidence. Methods This retrospective cohort study, analyzed in 2013–2015, used national Veterans Health Administration databases to identify MOVE! participants and eligible non-participants for comparison (2005–2012). Patients eligible for MOVE!—obese or overweight with a weight-related health condition, and no baseline CVD—were examined (N=1,463,003). Of these, 169,248 (12%) were MOVE! participants. Patients were 92% male, 76% white, with mean age 52 years and BMI of 32. The main outcome was incidence of CVD (ICD-9 and procedure codes for coronary artery disease, cerebrovascular disease, peripheral vascular disease, and heart failure). Results Adjusting for age, race, sex, BMI, statin use, and baseline comorbidities, over a mean 4.9 years of follow-up, MOVE! participation was associated with lower incidence of total CVD (hazard ratio [HR]=0.83, 95% CI=0.80, 0.86); coronary artery disease (HR=0.81, 95% CI=0.77, 0.86); cerebrovascular disease (HR=0.87, 95% CI=0.82, 0.92); peripheral vascular disease (HR=0.89, 95% CI=0.83, 0.94); and heart failure (HR=0.78, 95% CI=0.74, 0.83). The association between MOVE! participation and CVD incidence remained significant when examined across categories of race/ethnicity, BMI, diabetes, hypertension, smoking status, and statin use. Conclusions Although participation was limited, MOVE! was associated with reduced CVD incidence in a nationwide healthcare setting.