Get heart smart: Transforming cardiovascular health through diet and education

By Pooja Toshniwal PahariaReviewed by Lily Ramsey, LLMMar 21 2024

In a recent study published in BMJ Nutrition, Prevention, and Health, researchers evaluated the effectiveness of the Get Heart Smart (GHS) program in improving cardiovascular health.

Study: Evaluation of a 4-week interdisciplinary primary care cardiovascular health programme: impact on knowledge, Mediterranean Diet adherence and biomarkers. Image Credit: Sven Hansche/Shutterstock.com

Background

Cardiovascular disease is Canada's second-leading cause of mortality. Lifestyle changes can boost cardiovascular health by improving the lipid profile and blood pressure.

Limiting alcohol use, lowering stress, increasing physical activity, managing weight, stopping smoking, and eating a well-balanced, nutrient-dense diet, such as the Mediterranean diet, can optimize cardiovascular health.

The Mediterranean Diet promotes a high diet of unsaturated fats, fruits, leafy greens, wholegrain cereals, seeds, nuts, plant-origin proteins, moderate animal-based protein consumption, and minimal sweet intake.

A two-point rise in the Mediterranean Diet score is associated with better health, including lower mortality, CVD risk, neoplastic illness, and depression. Health education and motive planning can improve cardiovascular outcomes.

According to the Planned Behavior Theory, knowledge can robustly estimate involvement, which impacts intentions and subsequent behavior change.

About the study

In the present pragmatic, longitudinal cohort study, researchers explored the impact of the GHS program on cardiovascular outcomes.

The researchers enrolled 31 adults in the four-week GHS program formulated by the East Elgin Family Health Team dieticians based on referrals from healthcare practitioners or by themselves. Due to COVID-19, 16 participants attended the program virtually.

The program comprised four weekly educational sessions of 75 minutes each to improve participant awareness of BP and cholesterol management.

In addition, the program educated the participants on grocery store navigation from a cardiovascular perspective and reviewed diets that improve cardiovascular health [like the Mediterranean Diet, Portfolio Diet, and Dietary Approaches to Stopping Hypertension (DASH) diet].

In one session, a physician answered questions concerning cardiovascular medications. After each session, participants developed their SMART (specific, measurable, achievable, realistic, and timely) goals.

The team conducted in-person sessions between May 2019 and March 2020 and provided educational handouts to the participants.

They obtained blood samples from the participants for metabolic profile analysis and used the GHS knowledge questionnaire to assess participant awareness. The primary outcome was a change in Mediterranean Diet adherence after four weeks and six months of follow-up.

Secondary study outcomes included changes in glycated hemoglobin (HbA1c), blood pressure (BP), lipid profile [total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides], and an improved understanding of cardiovascular health after four weeks and six months.

In addition, the team compared cardiovascular outcomes between those attending in-person and virtually during COVID-19.

They performed two-way repeated-measures analyses of variance (RM-ANOVAs) to investigate GHS program effectiveness using data obtained between May 2019 and March 2023.

Results

The study population was primarily comprised of healthy female Caucasians, with a mean age of 61 years. GHS program participation was strong, with participants attending an average of 3.5 out of 4 sessions, with no significant differences between in-person and virtual attendance.

Knowledge ratings differed significantly between groups at baseline and after four weeks. Over six months, the team noted significantly higher Mediterranean Diet adherence and knowledge ratings in the in-person, virtual, and pooled samples. None of the biomarker alterations, except triglycerides, were statistically significant.

Following the four-week GHS course, the virtual group's Mediterranean Diet adherence improved significantly. After a six-month follow-up, adherence to the Mediterranean Diet was remarkably higher in the virtual and in-person groups.

The effect on Mediterranean Diet adherence increased considerably with time (partial eta squared for time: 0.4).

After four-week and six-month follow-ups, the pooled, virtual, and in-person groups showed significantly higher knowledge scores than at study initiation.

After four weeks, knowledge levels differed considerably between the virtual and in-person groups; however, the team found no statistically significant difference between groups after six months. As time passed, they found a considerable influence on participant knowledge (partial eta squared for time, 0.5).

The study found that the four-week cardiovascular health program significantly increased Mediterranean diet adherence, as seen by an increase in the mean Mediterranean Diet score from 7.0 to 9.2 after six months.

Significant gains in knowledge ratings were observed in both the virtual and in-person groups, showing the adoption of virtual programs.

Future research, however, must assess the program's effectiveness in larger sample sizes with higher gender and ethnic diversity and poor cardiovascular health to increase the generalizability and validity of the study findings.