Article Impact Level: HIGH Data Quality: STRONG Summary of JAMA Surgery. https://doi.org/10.1001/jamasurg.2024.3083 Dr. Jonathan Golledge et al.
Points
- A post hoc analysis of the BIP clinical trial assessed the impact of a brief walking promotion counseling intervention on reducing major adverse cardiovascular events (MACE) among 200 participants with peripheral artery disease (PAD).
- The intervention group showed a significantly lower risk of MACE than the control group, with a hazard ratio of 0.43, indicating a 57% reduction in risk.
- Higher disease-specific quality of life scores at 4 and 12 months were strongly associated with reduced MACE risk, suggesting that better quality of life may protect against cardiovascular events.
- Specifically, a 1-percentage point increase in Intermittent Claudication Questionnaire (ICQ) scores and a 1-unit increase in PAD Quality of Life (PADQOL) factor 3 scores correlated with significant reductions in MACE risk.
- The findings highlight the potential of lifestyle counseling to improve quality of life and reduce cardiovascular risk in PAD patients, supporting further exploration of structured physical activity interventions for enhancing patient outcomes.
Summary
In a post hoc analysis of the BIP randomized clinical trial conducted among 200 participants with peripheral artery disease (PAD) in three Australian cities, researchers evaluated the impact of a brief counseling intervention aimed at promoting walking to reduce major adverse cardiovascular events (MACE). The trial, which ran from January 2015 to August 2023, randomly assigned participants to either the intervention or control group in a 1:1 ratio. The primary outcome measured was the incidence of MACE, including myocardial infarction, stroke, and cardiovascular death. Results revealed that participants in the intervention group experienced a significantly lower risk of MACE compared to those in the control group (10 of 102 participants [9.8%] vs 21 of 98 [21.4%]; hazard ratio [HR], 0.43; 95% confidence interval [CI], 0.20-0.91; P = .03).
Further analysis focused on the relationship between disease-specific quality of life scores, measured by the Intermittent Claudication Questionnaire (ICQ) and PAD Quality of Life (PADQOL) scores, and the risk of MACE. The findings indicated that higher QOL scores at 4 and 12 months were associated with a reduced risk of MACE. Specifically, a 1-percentage point increase in ICQ scores correlated with a reduced MACE risk (HR per 1–percentage point increase, 0.97; 95% CI, 0.95-0.99; P < .001 at four months; P = .003 at 12 months), and a 1-unit increase in PADQOL factor 3 scores also showed a significant protective effect (HR per 1-unit increase, 0.91; 95% CI, 0.84-0.98; P = .01 at four months; P = .02 at 12 months).
The analysis suggests that interventions improving quality of life could significantly mitigate the risk of cardiovascular complications in patients with PAD. The association between the counseling intervention and reduced MACE risk is mediated by improved quality of life scores, underscoring the potential value of lifestyle counseling in managing cardiovascular risk in PAD patients. These exploratory findings advocate for further investigation into structured physical activity interventions to enhance patient outcomes in PAD.
Link to the article: https://jamanetwork.com/journals/jamasurgery/article-abstract/2822574
References Golledge, J., Venn, A., Yip, L., Leicht, A. S., Jenkins, J. S., Fiatarone Singh, M. A., Reid, C. M., Parmenter, B. J., Burton, N. W., Moxon, J. V., & BIP Investigators. (2024). Counseling Intervention and Cardiovascular Events in People With Peripheral Artery Disease: A Post Hoc Analysis of the BIP Randomized Clinical Trial. JAMA Surgery. https://doi.org/10.1001/jamasurg.2024.3083
