Family effects on cardiovascular disease evident

“Family matters in prevention and management of cardiovascular disease,” said Laura L. Hayman, PhD, professor of nursing at the University of Massachusetts Boston.

In her presentation, entitled “Family Interventions in Lifestyle Management” delivered during the American Heart Association (AHA) meeting, Hayman spoke on the rationale and evidence of supporting family-based interventions for preventing and managing heart disease. Among the issues she discussed were factors associated with lifestyle change in families, contextual/system factors central to lifestyle change in families, and directions for research, practice, and policy.

Among the evidence she highlighted were data showing that family history of cardiovascular disease (CVD) in biological parents and siblings (particularly in males younger than 55 years and females younger than 65 years) merits follow-up and assessment for CVD risk in other family members including children.

Other data show that CVD aggregates in families because of shared genes as well as potentially modifiable behaviors and family environments. “Health behaviors, such as patterns of physical activity or inactivity, dietary intake, and smoking are central components of prevention and management of CVD,” she said.

She also highlighted data showing various family-based interventions to improve heart health. Among these were data from a randomized controlled trial of 504 healthy adult family members of patients hospitalized for CVD that assessed the effects of a special intervention (i.e., personalized risk factor screening, therapeutic lifestyle counseling, and progress reports to physicians) versus usual care. At one year, the study found that 50% of family members were unaware they were at high CVD risk and that lifestyle changes were achieved in family members who underwent the special intervention.

“Targeting family members of patients hospitalized for a cardiac event provides a ‘teachable moment’ for providers to reach out to family members, assess risk for CVD, and recommend appropriate behavior change and other approaches to CVD risk reduction, depending on assessment of risk, “ said Hayman.

To illustrate the importance of contextual factors central to lifestyle changes in families, she described an academic-community-clinical partnership study that evaluated the feasibility and short-term impact on physical activity levels and cardiometabolic risk factors of a supervised after-school physical activity and nutrition program.

Named the EXCEL study, the study randomized 43 children in grades three to five to either an intervention of physical activity plus nutrition program (n=22) or nutrition only (n=21). Of the 36 children who completed the study, significantly more children who participated in the physical activity plus nutrition intervention had increases in light and moderate-to-vigorous physical activity compared to the children participating in the nutrition only intervention.

According to Hayman, this study highlights that “community and other resources are available to assist providers in promoting cardiovascular health in family members.”