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Learning Objective 1: The learner will be able to define global cardiovascular disease risk and describe the effect of behavior interventions on global cardiovascular disease risk.
Learning Objective 2: The learner will be able to describe behavioral interventions that reduce global cardiovascular disease risk and identify intervention attributes rendering them transportable worldwide.
Methods: An integrative review was performed in MEDLINE, CINAHL Cochrane database, and hand searching of reference lists. Inclusion criteria were behavioral techniques as interventions; global CVD risk (event rates or validated risk scores) as outcome; usual care as control (non-observational studies); adults; peer-reviewed; years 1981-2011; and English language. Exclusion criterion was participants with CVD. Studies were evaluated iteratively until no new themes were identified.
Findings: In 29 studies comprising 28,147 participants from 11 countries on 5 continents, the following themes were identified. Behavioral interventions decreased global CVD risk compared to baseline or usual care in 75% of the studies. Reduction in global CVD risk was achieved with low-intensity intervention. Forty percent of interventions were performed in a community environment. Design of the studies precluded identification of which behavior interventions were most effective. No studies assessed cost effectiveness. Three studies employed nurses; two were nurse-led and showed reduction in global CVD risk.
Conclusions: Behavior interventions reduce global CVD risk. Research is necessary to identify the most effective behavioral interventions.
Clinical Relevance: CVD kills more people worldwide than any other disease needlessly because 83% of CVD events can be prevented by controlling modifiable risk factors. Usual care with educational instruction has not controlled the CVD epidemic. Behavioral interventions are effective in modifying individual cardiovascular risk factors, yet effectiveness in reducing CVD event risk had not been previously demonstrated. Low-intensity community-based behavioral interventions are transportable worldwide to decrease CVD in individuals and populations. The paucity of nursing involvement in these studies challenges nurse leaders internationally to advance the critical role of nursing in this evolving application of behavioral science.