Using an online, personalized program reduces cardiovascular risk factor profiles in a motivated, adherent population of participants.

BACKGROUND Cardiovascular disease (CVD) is the leading cause of morbidity, mortality, and cost in Western society. Employer-sponsored work health programs (WHPs) and Web-based portals for monitoring and providing guidance based on participants' health risk assessments are emerging, yet online technologies to improve CVD health in the workplace are relatively unproven. We hypothesized that an online WHP, comprehensively addressing multiple facets of CVD, can be successfully implemented and improve the health of participants. METHODS A cohort of employees in Tennessee (n = 1,602) was subjected to a health risk assessment at baseline. Those who did not meet all 5 healthy benchmarks (n = 836)-body mass index, blood pressure, glucose, total cholesterol, and smoking status-were prospectively assigned to a Web-based personal health assistant and had repeat measurements taken at 90 days. RESULTS Of those who both completed the personal health assistant program and underwent baseline plus 90-day assessments (508/836, 61%), 75% were female, mean age was 46.5 ± 11.1 years, and the mean number of risk factors at baseline was 1.1 ± 0.9 with a mean 10-year Framingham Risk Score of 2.9%. This cohort demonstrated a significant reduction in total cholesterol (P < .0001), low-density lipoprotein cholesterol (P < .0001), triglycerides (P < .0001), systolic blood pressure (P = .009), glucose (P = .004), weight (P = .001), and body mass index (P = .001). Most of the participants improved at least 1 risk factor. Framingham Risk 10-year cardiovascular risk percentages were significantly reduced (P = .003). CONCLUSIONS This study in a prospective cohort of community-dwelling employees suggests that an online WHP can provide a viable means to improve surrogates of CVD risk factors.

[1]  G. Mancia,et al.  Influence of blood pressure reduction on composite cardiovascular endpoints in clinical trials , 2010, Journal of hypertension.

[2]  M. Woodward,et al.  The effects of blood pressure reduction and of different blood pressure-lowering regimens on major cardiovascular events according to baseline blood pressure: meta-analysis of randomized trials , 2011, Journal of hypertension.

[3]  E. Ford,et al.  Healthy lifestyle behaviors and all-cause mortality among adults in the United States. , 2012, Preventive medicine.

[4]  J. Kvedar,et al.  Evaluating a web-based self-management program for employees with hypertension and prehypertension: a randomized clinical trial. , 2012, American heart journal.

[5]  Nilay D Shah,et al.  Long-term medication adherence after myocardial infarction: experience of a community. , 2009, The American journal of medicine.

[6]  Ersen B. Colkesen,et al.  Initiation of health-behaviour change among employees participating in a web-based health risk assessment with tailored feedback , 2011, Journal of occupational medicine and toxicology.

[7]  Joshua T. Cohen,et al.  A Systematic Review of the Evidence Concerning the Economic Impact of Employee-Focused Health Promotion and Wellness Programs , 2013, Journal of occupational and environmental medicine.

[8]  James F Sallis,et al.  AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002 Update: Consensus Panel Guide to Comprehensive Risk Reduction for Adult Patients Without Coronary or Other Atherosclerotic Vascular Diseases. American Heart Association Science Advisory and Coordinating Committee. , 2002, Circulation.

[9]  R S Paffenbarger,et al.  The association of changes in physical-activity level and other lifestyle characteristics with mortality among men. , 1993, The New England journal of medicine.

[10]  D. Mozaffarian,et al.  Executive Summary: Heart Disease and Stroke Statistics—2015 Update A Report From the American Heart Association , 2011, Circulation.

[11]  S. Chapman,et al.  Measuring Interactivity on Tobacco Control Websites , 2012, Journal of health communication.

[12]  A. J. van der Beek,et al.  Short and long term effects of a lifestyle intervention for construction workers at risk for cardiovascular disease: a randomized controlled trial , 2011, BMC public health.

[13]  John Urquhart,et al.  Adherence to prescribed antihypertensive drug treatments: longitudinal study of electronically compiled dosing histories , 2008, BMJ : British Medical Journal.

[14]  V. Fuster,et al.  Risk factor control for coronary artery disease secondary prevention in large randomized trials. , 2013, Journal of the American College of Cardiology.

[15]  S. Yusuf,et al.  Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study , 2004, The Lancet.

[16]  F. Hu,et al.  Trends in cardiovascular health metrics and associations with all-cause and CVD mortality among US adults. , 2012, JAMA.

[17]  N. Unwin,et al.  Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Detection, Evaluation, and Treatment of High Blood Cholesterol Education Program (NCEP) Expert Panel on Executive Summary of the Third Report of the National , 2009 .

[18]  A. Maseri,et al.  Thrombin generation after fast or prolonged regimens of tissue-type plasminogen activator , 1993, The Lancet.

[19]  D. Magid,et al.  A Pharmacist-Led, American Heart Association Heart360 Web-Enabled Home Blood Pressure Monitoring Program , 2013, Circulation. Cardiovascular quality and outcomes.

[20]  J. Mckenney,et al.  Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). , 2001, JAMA.

[21]  S. Blair,et al.  Ideal cardiovascular health and mortality: Aerobics Center Longitudinal Study. , 2012, Mayo Clinic proceedings.

[22]  C. Lavie,et al.  Impact of worksite wellness intervention on cardiac risk factors and one-year health care costs. , 2009, The American journal of cardiology.

[23]  K. Furie,et al.  Heart disease and stroke statistics--2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. , 2007, Circulation.

[24]  Wei Li,et al.  Prevalence of a healthy lifestyle among individuals with cardiovascular disease in high-, middle- and low-income countries: The Prospective Urban Rural Epidemiology (PURE) study. , 2013, JAMA.

[25]  R. Lefebvre,et al.  Digital social networks and health. , 2013, Circulation.

[26]  K. Furie,et al.  Heart disease and stroke statistics--2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. , 2008, Circulation.

[27]  Mark D. Huffman,et al.  Executive summary: heart disease and stroke statistics--2013 update: a report from the American Heart Association. , 2013, Circulation.

[28]  D. Mozaffarian,et al.  Executive summary: heart disease and stroke statistics--2012 update: a report from the American Heart Association. , 2012, Circulation.

[29]  C. Hawn.  Take two aspirin and tweet me in the morning: how Twitter, Facebook, and other social media are reshaping health care. , 2009, Health affairs.

[30]  R. Lefebvre,et al.  The New Technology: The Consumer as Participant Rather than Target Audience , 2007 .

[31]  K. Uhlig,et al.  Self-Measured Blood Pressure Monitoring in the Management of Hypertension , 2013, Annals of Internal Medicine.

[32]  W. J. Elliott,et al.  Adherence to prescribed antihypertensive drug treatments: longitudinal study of electronically compiled dosing histories , 2009 .

[33]  Antonio C. H. Sek,et al.  Drug adherence and the incidence of coronary heart disease- and stroke-specific mortality among 218,047 patients newly prescribed an antihypertensive medication: A five-year cohort study , 2012, International Journal of Cardiology.