Background/Purpose: SLE patients have high rate of cardiovascular events due to increased prevalence of traditional cardiovascular disease (CVD)- and other lupus-related thrombosis risk factors. In addition, antiphospholipid antibody (aPL)- positive patients are at increased risk for thrombosis. We have developed a free-of-charge CVD prevention counseling program (PCP) for SLE and/or aPL-positive patients that provides a basic assessment of and education about the CVD and thrombosis risk factors (Arthritis Rheum 2009;60;S743). We report two-year patient reported outcomes in our ongoing CVD-PCP.

Methods: The CVD PCP consists of two phases: “assessment” (blood pressure, blood glucose, cholesterol profile, waist circumference, body mass index, family history of CVD, smoking status, Framingham 10-year CVD risk calculation, aPL-profile, and medications) and “education”(counseling about the above mentioned risk factors). Patients are followed every 3-6 months for a maximum of 3 years; they are questioned about their diet and exercise habits during each visit. In addition, patients are offered to fill out baseline and follow-up surveys during each visit. We analyzed diet and exercise habits in a descriptive fashion (Likert Scale; 1- 5, 5 is best). Repeated measures analysis was utilized to assess the change of the need for counseling on dietary and exercise habits over time. Our hypothesis was that over time there will be less need for counseling as a result of the program.

Results: Between 3/2009 and 12/2011, 115 SLE and/or aPL-positive patients received baseline counseling and 102/115 (89%) completed the baseline surveys. The mean (+ SD) scores for the baseline surveys were: a) improvement in patient’s knowledge about CVD risk factors: 4.3± 0.9; b) likelihood of the counseling program improving patients’ diet: 4.1 ± 1.1; and c) likelihood of the counseling program improving patients’ exercise pattern: 4.0 ± 1.1. Patients completed surveys during 268/429 (63%) of follow-up visits (range: 3-33 months); some-to-significant improvement in the diet and exercise habits were reported during 251 (94%) and 225 (84%) of the visits, respectively. Repeated measures analysis showed that there was a significant decrease over time of the need for counseling on all dietary habits investigated (fruits, vegetables, whole-grain, fiber, fish) and 30 min/day exercise habits mostly starting at 9-12 months, continuing up to 2 years (Table). 

Variable	3 or 6m Visit OR (95%CI)	9 or 12m Visit OR (95%CI)	15 or 18m Visit OR (95%CI)	21 or 24m Visit OR (95%CI)
Need for counseling on Fruits & Vegetables	0.63 (0.32-1.26)	0.44 (0.22-0.88)*	0.24 (0.1-0.54)*	0.20 (0.08-0.51)*
Need for counseling on Whole-Grain & High-fiber	0.62 (0.31-1.22)	0.4 (0.3-0.8)*	0.48 (0.23-0.99)*	0.22 (0.09-0.52)*
Need for counseling on Fish	0.51 (0.3-1.02)	0.4 (0.54-0.8)*	0.41 (0.2-0.86)*	0.33 (0.15-0.73)*
Need for counseling on Cholesterol Free Diet	0.50 (0.21-1.15)	0.70 (0.29-1.66)	0.95 (0.27-1.09)	0.72 (0.27-1.93)
Need for counseling on exercise at least 30 min/day	0.33 (0.15-0.71)*	0.23 (0.11-0.5)*	0.28 (0.13-0.63)*	0.19 (0.08-0.44)*

Conclusion: Two year preliminary analysis of our ongoing CVD prevention counseling program demonstrates our patients’ belief that the program is helping them make healthful lifestyle choices in terms of diet and physical exercise. These findings are supported by the significant reported improvement in their diet and exercise. The three-year longitudinal analysis of clinical outcomes will determine the true effectiveness of the program with respect to decreasing the prevalence of cardiovascular disease risk factors.  

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cardiovascular-disease-prevention-counseling-program-for-systemic-lupus-erythematosus-andor-antiphospholipid-antibody-positive-patients-two-year-preliminary-analysis-of-diet-and-exercise-habits/