OBJECTIVE: To compare the treatment effect on lifestyle-related risk factors (LRFs) in older (>= 65 years) versus younger (< 65 years) patients with coronary artery disease (CAD) in the Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists 2 (RESPONSE-2) trial. METHODS: The RESPONSE-2 trial was a community-based lifestyle intervention trial (n = 824) comparing nurse-coordinated referral with a comprehensive set of three lifestyle interventions (physical activity, weight reduction and/or smoking cessation) to usual care. In the current analysis, our primary outcome was the proportion of patients with improvement at 12 months follow-up (n = 711) in >= 1 LRF stratified by age. RESULTS: At baseline, older patients (n = 245, mean age 69.2 +/- 3.9 years) had more adverse cardiovascular risk profiles and comorbidities than younger patients (n = 579, mean age 53.7+/-6.6 years). There was no significant variation on the treatment effect according to age (p value treatment by age 0.45, OR 1.67, 95% CI 1.22 to 2.31). However, older patients were more likely to achieve >= 5% weight loss (OR old 5.58, 95% CI 2.77 to 11.26 versus OR young 1.57, 95% CI 0.98 to 2.49, p = 0.003) and younger patients were more likely to show non-improved LRFs (OR old 0.38, 95% CI 0.22 to 0.67 versus OR young 0.88, 95% CI 0.61 to 1.26, p = 0.01). CONCLUSION: Despite more adverse cardiovascular risk profiles and comorbidities among older patients, nurse-coordinated referral to a community-based lifestyle intervention was at least as successful in improving LRFs in older as in younger patients. Higher age alone should not be a reason to withhold lifestyle interventions in patients with CAD.
Reproduced with permission from the BMJ Publishing Group.

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