Changes in serum cholesterol in employees after three years of multifactorial intervention.

BACKGROUND: To assess long-term effectiveness of a multifactorial intervention at the work-site on serum cholesterol levels. METHODS: Individualized face-to-face counseling was given to 1,555 employees (76.7% male; mean age = 42.3 years) by occupational physicians at four work-sites. After 3 years, a blinded assessment of the adequacy of the intervention was done. Implementation of the intended intervention by physicians was assessed as adequate in two work-sites (927 employees) and inadequate in the other two (628 employees). Observed changes in serum cholesterol were analyzed in the followed-up individuals. Follow-up rates at each work-site were 78.6% and 44.5% for the adequate intervention, and 85.5% and 60.4% for the inadequate intervention. Changes in serum cholesterol were controlled for potential confounding factors (pre-test levels of risk factors, age, sex, body mass index, educational level, marital status, physical activity and alcohol consumption) by multiple linear regression procedures. RESULTS: When the intervention was adequately performed, serum cholesterol was significantly lowered with a mean reduction of 14.3 mg/dl (95% C.I.: 11.0 to 17.6) in those employees with baseline levels > or = 200 mg/dl. CONCLUSIONS: Adequacy of implementation of work-site programs determines their long-term effectiveness in reducing mean serum cholesterol levels.

[Changes in arterial pressure and smoking habit following 3 years of multifactorial intervention]. / Cambios en la presión arterial y en el hábito tabáquico tras 3 años de intervención multifactorial.

BACKGROUND: The feasibility of successfully reducing cardiovascular risk factors is supported by large studies. Nevertheless, controversy remains about the actual efficacy of some lifestyle interventions. This report assess the effectiveness of different levels of intervention at the work-site on blood pressure and smoking. METHODS: At the beginning of the program 1.193 men and 362 women were included in it. Individualized face-to-face counseling was given to employees by four different occupational physicians. After 3 years, 980 individuals remained in the study. The differences among the four groups allowed us to distinguish three different levels of intensity of interventions and a fourth group that was the reference one. Observed changes in blood pressure were compared using analysis of covariance. Adjusted odds ratio of smoking quit rates were calculated by logistic regression. RESULTS: Intensive intervention was significantly different from control group and the group of mild intervention. Moderate intervention was the only one to bring about a significant reduction of arterial blood pressures. This reduction was consistent with the lower threshold used in this group to classify diastolic blood pressure as high. Smoking quit rate was 22% for intensive and moderate interventions. Adjusted odds ratio for quitting smoking was 5.81 (95% CL 1.29-26.14) for moderate and 8.2 (IC 95% 1.75-38.46) for intensive intervention. CONCLUSIONS: A lower threshold for starting intervention measures on blood pressure is suggested to achieve better results. As the intensity of interventions was stronger, smoking quit rates were higher.

Life-style factors associated with changes in serum lipids in a follow-up study of cardiovascular risk factors.

We studied some life-style characteristics that may predict changes in total serum cholesterol and cholesterol bound to high density lipoproteins (HDL-cholesterol) in a sample of 980 healthy Spanish employees of both sexes who were followed for three years. All workers participated in a multifactorial program aimed at preventing cardiovascular disease. Linear regression models were fitted with changes in total and HDL-cholesterol as the dependent variables, after eliminating variability due to the influence of basal values. The association between lifestyle factors and lipid changes was controlled for dietary modifications. In the multivariate analysis, decreases in body mass index, and in alcohol consumption were associated with significant reductions in total serum cholesterol. Maintaining sports at post-test or starting to practice them in the interim was also significantly and independently associated with favourable changes in serum cholesterol. Leisure-time exercise (p = 0.002) and giving up smoking (p = 0.06) were each associated with increased HDL-cholesterol.

Changes in coronary risk profiles in employees after three years of multifactorial intervention.

This study was performed with the objective of assessing the effectiveness of the intervention at the work-site on lifestyle-related cardiovascular risk factors in four work-sites in Granada, Spain. Individualized face-to-face counseling was given to 1555 employees (1193 men and 362 women). After 3 years, a blinded assessment of the adequacy of the interventions was carried out. When changes in all employees were analysed together, ('per protocol' analysis) a non-significant reduction (-0.02%; 95% CI: -0.06 to +0.03%) in mean coronary risk was observed. We also distinguished between adequate and inadequate implementation of the intervention protocol. Observed changes in mean coronary risk were compared between both groups (adequate/inadequate implementation). Changes in mean coronary risk were beneficial only in the group that achieved an adequate level of intervention, with an observed significant mean reduction of risk of -0.12% (95% CI: -0.07 to -0.17) whereas changes were in the opposite direction in the other group with a mean change of +0.08% (95% CI: + 0.01 to + 0.16%). Work-site programs of health behaviour modification when appropriately implemented can attain although small, significant changes in cardiovascular risk profiles and thus be especially effective in achieving the population strategy of preventive cardiology.