Peer Group Intervention May Thwart Cardiovascular Disease

Peer support group
Peer support group
Results from the Fifty-Fifty trial demonstrated the success of peer support in reducing cardiovascular risk factors.

ORLANDO, Fla. — One year’s participation in a comprehensive, peer group-based lifestyle intervention improved a number of cardiovascular (CV) risk factors and healthy behaviors, according to data from the randomized, controlled Fifty-Fifty trial.

The results were presented at the American Heart Association Scientific Sessions and simultaneously published in the Journal of the American College of Cardiology.

“The concept is simple,” study investigator Valentin Fuster, MD, PhD, of Icahn School of Medicine at Mount Sinai in New York, said during a late-breaking clinical trials session. “Peer support is proven to be a beneficial strategy for substance abuse, like Alcoholics Anonymous, for example. So why not consider similar peer support to modify cardiovascular global risk factors and behavior?”

Before the Fifty-Fifty trial, 2 pilot studies were conducted in Grenada and Cardona, Spain, with the goal of evaluating 2 completely heterogeneous populations, Dr Fuster explained.

After the 2 pilot studies, the government of Spain initiated the trial in 7 communities, with 648 individuals being eligible for the study. To qualify for inclusion, participants had to be 25 to 50 years of age and had to have at least 1 of the following risk factors: overweight or obesity, physical inactivity, smoking, or hypertension.

Of the 648 eligible participants, 543 were randomly assigned to a peer group-based intervention group (n=277) or self-management control group (n=266).

Prior to randomization, all enrolled participants attended 6 workshops on core lifestyle and CV risk factor education that addressed motivation to change, physical activity, healthful diet, smoking cessation, stress management, and self-control of blood pressure.

For the intervention, participants were organized into small groups of 10. They then selected a group leader who moderated monthly, 60- to 90-minute meetings that involved role-play, brainstorming, and activities to address emotions, diet, and exercise.

The researchers employed a weighted system that included 7 variables of CV health according to the American Heart Association, including blood pressure, exercise, weight, alimentation, and tobacco, called the Fuster BEWAT score, in their analysis. Each individual component was scored on a scale of 0 to 3, with a maximum score of 15.

Mean change in the BEWAT score served as the primary outcome, while the secondary outcome included mean changes in individual components of the BEWAT score.

Of the 543 participants, 71% were women and 71% were aged 40 to 50 years.

After 1 year, results revealed a very significant, nearly 1-point increase from 8.17 to 8.84 in average whole BEWAT score in the intervention group (P=.02), compared with a nonsignificant increase from 8.34 to 8.41 (P=.88) in the control group, reported Dr Fuster.

The researchers also observed a trend towards improvement in each of the individual components with the intervention, with a significant difference seen for the tobacco component (P=.003).

Evaluating the results in the context of adherence was also of interest, Dr Fuster noted. Participants with high adherence, defined as attending at least 7 sessions, exercised more and had a smaller waist circumference, as compared with those who had low adherence.

The study had limitations, including the use of self-reported outcomes, the fact that a greater proportion were women, and a drop-out rate of 16%. However, the intention-to-treat analysis used in the study was a conservative approach that accounted for study, gender, age, and municipality, according to Dr Fuster.

“I’d like to conclude that the Fifty-Fifty peer group-based lifestyle management program had a positive impact on the participants, showing an overall improvement of the BEWAT score and its behavioral components, especially smoking sessions,” he said.

“Wider adoption of such a program may have a meaningful impact on cardiovascular health promotion.”

He noted that another follow-up assessment will be performed 1 year after these final data to evaluate whether or not these results were sustained.

In an accompanying editorial published in the Journal of the American College of Cardiology, Fatima Rodriguez, MD, MPH, and Robert A. Harrington, MD, both from Stanford University in California, highlighted a few of the innovations offered by the Fifty-Fifty Program, including addressing multiple aspects of CV health such as health behaviors and health metrics vs just 1 risk factor.

Additionally, they noted the use of the psychological interventions of peer support and group dynamics to produce positive results.

“Challenging public health problems necessitate creative community-based and community-endorsed health delivery models. As we continue to move forward with digital health interventions, future studies should link peer-based interventions with mobile health for increasing scalability,” they wrote.

“Such strategies will require research to determine if digital interventions are as effective as in-person encounters and if these types of peer visits can substitute for or supplement clinical encounters, but it is likely that targeting individuals in their communities offers the best solution to creating positive lifelong health behavior practices.”


  1. Fuster V. LBCT.02 – Decreasing the Global Burden of Disease: Breakthroughs in Prevention. Impact of a Comprehensive Lifestyle Peer-group-based Intervention on Cardiovascular Risk Factors: A Randomized Controlled Trial. Presented at the American Heart Association Scientific Sessions; November 7-11, 2015; Orlando, FL.
  2. Gómez E, Fernández-Alvira JM, Vilanova M, et al. A Comprehensive Lifestyle Peer-Group-Based Intervention on Cardiovascular Risk Factors: The Randomized Controlled Fifty-Fifty Program. J Am Coll Cardiol. 2015;doi:10.1016/j.jacc.2015.10.033.
  3. Rodriguez F, Harrington RA. The Role of Peer Support in Attaining Ideal Cardiovascular Health: Peer Pressure and Prevention. J Am Coll Cardiol. 2015;doi:10.1016/j.jacc.2015.10.032.