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To assess whether electronic (e-) coaching, using personalized web-based lifestyle and risk factor counselling with additional email prompts, provides additional risk reduction when added to standard of care (SOC) in individuals at increased risk. Between June 2013 and May 2015, 402 participants were allocated 1:1 to e-coaching and SOC versus SOC. Participants free of manifest cardiovascular disease, with internet access, and a 10-year QRISK2 cardiovascular risk of ≥10% were enrolled. Change in oscillometric carotid-femoral pulse wave velocity (PWV) from baseline to six months was the primary endpoint. Secondary outcomes included change in blood pressure (BP), weight, and risk scores. Analysis was by intention to treat. Mean (±SD) age was 65.5 (5.6) years with 37% females. Primary outcome data were available for 94%. There was no difference in PWV reductions between e-coaching and standard of care groups (-0.16 m/s vs. -0.25 m/s, 95% confidence interval -0.39 to 0.22, p = 0.56). There were no differences in the improvement between groups for BP, weight, Framingham, or QRISK2 scores. Pulse wave velocity change was more favorable in those with a higher level of education (p = 0.04), but was not associated with age, gender, presence of diabetes, baseline QRISK2 score, or logins to the website. In individuals at increased cardiovascular risk, a comprehensive 'health check' program modestly reduced future risk. Personalized e-coaching did not provide added risk reduction. Currently there is no evidence to routinely recommend e-coaching in cardiovascular health check programs. HAPPY London ClinicalTrials.gov: NCT01911910.

IntroductionCardiovascular disease (CVD) remains the leading cause of morbidity and mortality globally. The importance of primary prevention (PP) of CVD is now well recognised and can potentially improve quality of life and survival cost-effectively.AimTo assess benefits of contemporary guideline based PP recommendations for CVD risk reduction in those with elevated global cardiovascular risk.Methods402 participants aged 40–74 years were recruited as part of the HAPPY London study. Eligible participants had an elevated 10-year risk based on a QRISK2 score of 10% or more. Internet access was required to be able to register and complete questionnaires online. Individualised one-off cardiovascular risk reduction advice was provided, based on the JBS3 and ESC 2012 CVD prevention guidelines. Follow-up at 3 months assessed changes in risk factors and risk scores using paired t-test statistical analysis.ResultsMean age 65 years; 37% females and 370 (92%) completed the 3-months follow up. There was a small but significant improvement in mean blood pressure from 132/80 mmHg to 129/78 mmHg (p < 0.001). Other improvements included weight, waist circumference, fasting glucose, total cholesterol, physical activity, Framingham and QRISK2 scores (Table 1).QRISK2 score dropped from 18.9% to 18.5% at follow-up. This was a 0.7% absolute reduction compared to expected resulting in about 660 less CVD events per 100,000 over 10 years.ConclusionsImplementing guideline recommendation for CVD PP can produce modest improvements in risk factors in the medium term in patients at high cardiovascular risk. Promoting long-term compliance should help lower future cardiovascular events.Abstract 84 Table 1Baseline and follow up measurementsVariable (mean)Baseline3 MonthsP value95%CI of differences Systolic BP (mmHg)132.4129<0.0012.364.77Diastolic BP (mmHg)79.678<0.0011.002.35Weight (kg)80.379.2<0.0010.551.02BMI (kg/cm2)27.727.4<0.0010.180.34Waist circumference (cm)95.693.8<0.0010.961.92Framingham score (%)17.415.8<0.0011.042.1QRISK2 score (%)18.918.50.0160.060.57Total cholesterol5.04.8<0.0010.170.31Glucose5.85.6<0.0010.10.3LDL2.82.7<0.0010.090.22