| Sumario: | QUESTION: In people without evidence of established cardiovascular disease, do counselling or educational interventions reduce cardiovascular risk factors, deaths from all causes, and deaths from coronary artery disease (CAD)? Data sources: Studies were identified using Medline (1966 to April 1990), bibliographies of relevant studies, and be contacting experts. Study selection: Studies were selected if they were randomised controlled trials with >/= 6 months of follow tip of counselling or educational interventions with or without medications aimed at controlling >/= 1 cardiovascular risk factor (blood pressure, smoking, total blood cholesterol, physical activity, and diet) in people >/= 40 years of age without evidence of cardiovascular disease. Data extraction: Data were extracted independently by 2 reviewers on methodological quality of the trials, patient baseline characteristics, and follow up. Outcomes were changes in blood pressure and total blood cholesterol, smoking, deaths from all causes, and deaths from CAD. Main results: 18 trials (140 245 patients) were included. Heterogeneity existed among the trials for all outcomes except CAD mortality. One reason for heterogeneity was the inclusion of trials that studied only hypertensive patients. Blood pressure, total blood cholesterol, and smoking prevalence were reduced in patients who received risk factor modification compared with patients who received no intervention or usual care (table). 10 trials included clinical outcomes. Deaths from all causes or from CAD were not reduced by risk factor modification (table). Conclusion: In people without evidence of established cardiovascular disease, multiple risk factor interventions consisting of counselling or educational interventions show modest reductions in blood pressure, blood cholesterol, and smoking prevalence, but not deaths from all causes or from coronary artery disease. [Original article accession number: 2000006802 (research, systematic review, tables/charts)]
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