A new study reveals that patients with vascular disease have an elevated risk of experiencing a further event or death. Evidence shows that the risk can be effectively reduced by nurse practitioners that treat any vascular risk factors. However, this is costly and time-consuming and goals are often not achieved.

Unlike previous studies, which failed to demonstrate clear benefits, the new study focused on the 1-year effect in a fairly large patient cohort.

The team from The Netherlands' University Medical Center in Utrecht decided to conduct a randomized controlled 12-month long trial of 330 participants to evaluate whether an internet-based program would prove effective in decreasing vascular risk factors in those suffering from the disease. The program consisted of a personalized website and included email communication with a nurse practitioner through the website, monitoring of disease control, self-management support, as well as pharmacotherapy.

The Framingham Heart Score is designed for patients with no vascular disease and calculates the predicted 10-year risk for coronary heart disease. After the end of the 12-months study, the team discovered that the measured Framingham Heart score displayed a relative change.

In comparison to controls, the team noted a further drop of 12% in the Framingham Heart Score after one year amongst those that participated in the internet-based program. Furthermore, the program revealed a small, statistically important difference in participants' risk scores in two out of three analyses. The team also measured various factors, including whether the participants had ever smoked, blood pressure, their height, weight and waist circumference. The team noted that 8 smokers quit smoking compared with 4 in the usual care group, and that BMI, blood pressure and renal function had improved.

The researchers have come to the conclusion that adding an internet-based nurse-led vascular prevention program, in addition to usual care, can potentially decrease the long-term risk of vascular event or death. However, they point out that the clinical importance of this is "small and limited," adding that it would be easy to implement this intervention into clinical practice and that it may prove to be of benefit for various high risk groups of patients for cardiovascular risk.

Article reference："Internet based vascular risk factor management for patients with clinically manifest vascular disease: randomised controlled trial"
J W P Vernooij, PhD, H A H Kaasjager, Y van der Graaf, J Wierdsma, H M H Grandjean, M M C Hovens, G A de Wit and F L J Visseren
BMJ, June 2012, doi: 10.1136/bmj.e3750