Sustained cardiometabolic risk reduction in a multidisciplinary preventive cardiology center

Abstract Background/Introduction Sustained cardiometabolic risk reduction is elusive in clinical practice and critical for successful population health. Purpose To determine whether sustained cardiometabolic risk reduction can be better achieved in a multidisciplinary preventive cardiology center compared with usual cardiology care. Methods Patients from our Heart Hospital multidisciplinary preventive cardiology center (Intervention Group [INT]) vs. contemporaneous usual care – patients from our Hospital but not from the multidisciplinary preventive cardiology center - (Control Group [C]) with 2-5 years of follow-up for cardiometabolic drivers (abnormal adiposity, dysglycemia, hypertension, and dyslipidemia) were retrospectively included. The primary outcome was the comparison of yearly changes in cardiometabolic driver traits (% change in body weight [%DBW], hemoglobin A1c [A1C], fasting blood glucose [FBG], systolic blood pressure [SBP], diastolic blood pressure [DBP], and low-density lipoprotein [LDL-C]). Results A total of 449 patients were included, of whom 308 were in the INT and 141 were in the C groups. Reductions in %DBW, SBP, and FBG were significantly larger in the INT than the C groups: higher %DBW was observed in the INT group in the first (-0.99 ± 4.62 vs. -2.1 ± 5.24%; p=0.040) and sustained in the second (-0.98 ± 6.92 vs -2.43 ± 6.64%; p=0.036) and third (-1.31 ± 7.97 vs. -3-32 ± 7.52%; p=0.021) years of follow-up; SBP reduction was observed in the INT in the first (-1.57 ± 16.79 vs. -7.28 ± 16.96 mmHg; p=0.002) and sustained in the second (-1.4 ± 17.86 vs. -7.69 ± 18.09 mmHg; p=0.001), third (-1.69 ± 18.98 vs. -7.64 ± 20.05 mmHg; p=0.007), fourth (-1.08 ± 21.34 vs. -8.96 ± 19.57 mmHg; p=0.006), and fifth (-0.49 ± 20.97 vs. -8.16 ± 22.73 mmHg; p=0.033) years of follow-up; and FBG reduction was observed in the INT in the third (13.57 ± 52.96 vs. -11.58 ± 48.4 mg/dL; p=0.003) and sustained in the fifth (5.04 ± 26.4 vs. -17.77 ± 55.4 mg/dL; p=0.007) years of follow-up. No significant differences between INT and C groups were observed over five years for A1C and LDL-C and in the other years for %DBW and FBG. Conclusions In patients with cardiometabolic risk factors, sustained improvements in %DW were observed for three years, and in SBP and FBG for five and two years, respectively. These sustained improvements can be better achieved in a multidisciplinary preventive cardiology center than with usual clinical care. Further studies are needed to confirm these results especially in different settings, populations, and cardiometabolic risk profiles.