Global burden of disease Sweden www.healthmetricsandevaluation.org - - PowerPoint PPT Presentation

23/05/2015 1

A cardio-metabolic high risk individual –

the process and results of participating in a structured lifestyle intervention program for one year

Matthias Lidin, Specialistnurse in cardiovasular nursing Ph D student, Karolinska Institutet Lifestyle Unit, Department of Cardiology, Karolinska University Hospital Stockholm, Sweden

Global burden of disease Sweden

www.healthmetricsandevaluation.org

Global Burden of Disease, Sweden

Smoking Diabetes Psyosocial factors High blood lipids Food habits Alcohol High High b blood pressure lood pressure Overweight Overweight Abdominal obesity Abdominal obesity Physical Physical activity activity

Yusuf S et al, Lancet 2004;364:937-52

Case-control Study, myocardial infarction (n 15 152), controls (n 14 820), 74 % men, 52 different countries

The InterHEART – Study

Unhealthy Lifestyle faktors

• Smoking
• Unhealthy food habits
• Physical inactivity
• Sedentary habits

Risk factors

• Abdominal obesity
• Hypertension
• Hyperlipidemia
• Metabolic syndrome

Case Bosse Man 61 years old Divorced Lives alone Taxidriver Parameter

Value

Blood pressure

145/85 mmHg

Pulse

75 beats /min

Weight

102 kg

Waist

135 cm Total Cholesterol 6,5 mmol/l LDL 4,5 mmol /l HDL 0,9 mmol/l Heart score 9 %

Baseline visit

Lifestyle intervention

• Individual visit – nurse based, person centred lifestyle advice,
• Questionnaire, physical examination, blood samples; baseline, 6 months

and 1 year

• Five structured group meetings with a physician and a nurse - physical

inactivity, food habits, nicotine, alcohol, stress and cognitive behavior therapy

Intervention

Primary care and hospital care Cardiovascular prevention For patiens with cardiovascular disease or risk

The individual visit – nurse

ü Blood pressure, heart rate, waist circumference , weight,

height , BMI and Body Composition

ü Fasting: Total cholesterol, triglycerides, LDL, HDL, APOB och APOA1, p-glucose,

HbA1C, TSH, S-Crea, g-GT och hsCRP

ü Questionnaire: quality of life, food habits , alcohol, nicotine habits, physical

activity/inactivity , sedentary habits and stress

ü Visit: Baseline, after 6 months and 1 year ü Documentation / Patient file ü Physical activity on prescription - PaP ü Pedometer

Life style counselling for Bosse

• Person-cetered approache
• Motivated behavior change interveiw techniques (MI)
• Based on Science
• Using Life style related tools ex
• Heart score
• Physical activity on precription (PAP) – PA and sedentary time / pedometer
• Food brochures' ( focusing on Smart chioes ) more vegetable /less meat
• Stop smoking brochures' and internet/ telephone line help

Improved Lifestyle faktors

• Non smoker
• Eats more vegetables/fish and

less meat

• Brisk walks and Gym-training
• Less sedentary – pedometer

Improved Riskfactors

• waist -curcumferens : normal
• Blodpressure : normal
• Cholestrol : normal

Case / Bosse Man 61 years old Visit 6 month Visit 1 year Telephone contact –Stop smoking Parameter

Value

Blood pressure 120/80 mmHg Pulse 62 beats /min Weight 95 kg Waist 98 cm

Total Cholesterol

4,5 mmol/l

LDL

2,8 mmol/l

HDL 1,3 mmol/l Heart score 2 %

One year folow-up

Conclusion

• Reduced cardiometabolic risk in an individual

participating in our structured lifestyle intervention

• More studies are needed for stronger evidence

and more effective implementation

THANK YOU!!