Lifestyle counselling in primary care: long-term effects on cholesterol level.

Objective: To evaluate the long-term effectiveness of lifestyle counselling for low-moderate cardiovascular (CV) risk subjects in primary care.

Design: Prospective comparison of baseline vs post-intervention, and comparison of enrolled patients vs control subjects extracted from a large primary care database.

Setting: 94 general practices in Italy.

Participants: All the 20-70-year-old hypercholesterolaemic subjects who did not qualify for statin treatment according to the guidelines and who were seen on 12 predetermined working days; 713 patients; 94 general practitioners.

Intervention: Short (5-10 min) educational intervention (qualitative dietary advice, encouraging walking or other aerobic physical activities); handing out simple dietetic advice at physician discretion.

Main Outcome Measures: Total cholesterol level and global CV risk calculated according to the Framingham equation.

Results: Total cholesterol and global CV risk (10 years) decreased by 0.31 mmol/l (p < 0.0001, 95% CI 0.23-0.40) and 1.35% (p < 0.01, 95% CI -1.73 to -0.97), respectively, after a 54-month follow-up. Enrolled patients showed a greater total cholesterol decrease than control patients: 2.24% (p < 0.05, 95% CI 0.58-3.91%).

Conclusions: A simple, office-based, long-term, lifestyle counselling programme produces a small, but clinically significant reduction of total cholesterol and of global CV risk. This result should encourage GPs to systematically offer simple, unstructured lifestyle counselling to all their patients.