Dose-dependent effects of lifestyle interventions on blood lipid levels: Results from the PREMIER trial.
Ramzi Dudum, Stephen P Juraschek, Lawrence J Appel
PMID 31153659WHAT IT FOUND
Structured counseling lowered LDL-C at six months, but not at eighteen.
The counseling was individual and group sessions about physical activity, weight loss, sodium reduction, reduced fat/calorie diet, and DASH diet, so no single component can be credited.
Key findings
01At six months, the two multi-component lifestyle counseling groups showed significant LDL-C reductions compared with advice only: 5.6 mg/dL in Established and 4.0 mg/dL in Established Plus DASH.
02At six months, Established had lower triglycerides by 19.7 mg/dL, total cholesterol by 7.3 mg/dL, and waist circumference by 3.6 cm; Established Plus DASH had lower total cholesterol by 5.7 mg/dL and waist circumference by 3.2 cm than Advice Only.
03At eighteen months, no significant LDL-C differences remained between randomized groups.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Participants were enrolled based on blood pressure, not lipid values, so the trial was not designed for people selected for high cholesterol. The LDL-C benefit did not persist at later follow-up. The adherence analysis was observational and could be confounded by factors other than session attendance. The intervention included several lifestyle components at once, so the effect of any single component cannot be separated. Participants taking lipid-lowering medication were excluded, so results do not apply to people already on such treatment. Missing data were not imputed.
Declared interests
The supplied metadata indicates NIH extramural research support. No conflict-of-interest declaration is included in the article text.
The easy way to misread this
Do not read the session-attendance dose response as proof that more counseling caused lipid reductions. That analysis was observational, not randomized, and the intervention combined individual and group counseling about physical activity, weight loss, sodium reduction, reduced fat/calorie diet, and DASH diet, so no single component can be credited.