Lifestyle intervention with or without risk-factor passport to reduce cardiovascular disease risk factors at the HIV outpatient clinic.

HIV infected individuals have a greater risk of cardiovascular disease (CVD) than HIV-negative individuals of the same age and gender. Non-pharmacological lifestyle interventions to reduce CDV are deemed first choice in HIV infected patients to prevent polypharmacy and its potential complications. Research has shown that CVD risk factors are highly prevalent among HIV infected persons >45 years attending the HIV outpatient clinic of the AMC. HIV infected persons from the AMC will be approached to participate in a lifestyle intervention protocol, targeting smoking cessation and weight reduction, to reduce CVD risk as part of routine clinical care. Achieving and sustaining behaviour change is a major and perpetual challenge in medicine, however. Providing individuals with personalised health-related risk information with visual feedback about disease risks may be a method of increasing motivation for behaviour change.

With the present study we aim to investigate if providing visual feedback about an individuals’ personal CVD risk and to show the target risk that can be reached if lifestyle factors are optimally treated (“risk factor passport”) has additional value in reducing CVD risk, among patients who participate in a lifestyle intervention protocol at the HIV outpatient clinic of the AMC.

Both patients randomly assigned to the intervention group with the risk factor passport and the control group without risk factor passport will receive routine care according to the lifestyle intervention protocol at months 0, 3, 6, 9 and 12. In both groups, lipid levels and blood pressure will be measured at each follow-up visit. The 5-year CVD risk score at month 12 is the primary outcome measure.

To investigate if providing visual feedback about an individuals’ personal CVD risk (risk factor passport) and the target risk that can be reached if lifestyle factors are optimally treated has additional value in reducing CVD risk, among patients who participate in a lifestyle intervention protocol at the HIV outpatient clinic of the AMC.

Months 0, 3, 6, 9 and 12.

Both the intervention group with the risk factor passport and the control group without risk factor passport will receive routine care according to the lifestyle intervention protocol at months 0, 3, 6, 9 and 12. In both groups, lipid levels and blood pressure will be measured at each follow-up visit.



In addition to routine care, patients assigned to the intervention group will receive the risk factor passport. At baseline (month 0) the HIV counseling nurse will explain the presence of modifiable and un-modifiable CVD risk factors. Second, the patient will receive a risk-factor passport that will serve as a risk communication tool. The risk-factor passport shows a graphical presentation of the patient’s calculated 5-year CVD risk. It will also show the target risk that could be reached if all the patient’s modifiable risk factors are optimally treated. The nurse will calculate the patients CVD risk using the online DAD risk calculator, specifically designed for HIV infected patients (7, 8). The patients’ CVD risk will also be calculated at follow-up visits at month 3, 6, 9 and 12 and the risk factor passport will be updated accordingly.