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Meta-Analysis
. 2016 Mar 11;18(3):e55.
doi: 10.2196/jmir.5218.

Web-Based Interventions Targeting Cardiovascular Risk Factors in Middle-Aged and Older People: A Systematic Review and Meta-Analysis

Cathrien R L Beishuizen  1 , Blossom C M Stephan, Willem A van Gool, Carol Brayne, Ron J G Peters, Sandrine Andrieu, Miia Kivipelto, Hilkka Soininen, Wim B Busschers, Eric P Moll van Charante, Edo Richard
Affiliations
Meta-Analysis

Web-Based Interventions Targeting Cardiovascular Risk Factors in Middle-Aged and Older People: A Systematic Review and Meta-Analysis

Cathrien R L Beishuizen et al. J Med Internet Res. .

Abstract

Background: Web-based interventions can improve single cardiovascular risk factors in adult populations. In view of global aging and the associated increasing burden of cardiovascular disease, older people form an important target population as well.

Objective: In this systematic review and meta-analysis, we evaluated whether Web-based interventions for cardiovascular risk factor management reduce the risk of cardiovascular disease in older people.

Methods: Embase, Medline, Cochrane and CINAHL were systematically searched from January 1995 to November 2014. Search terms included cardiovascular risk factors and diseases (specified), Web-based interventions (and synonyms) and randomized controlled trial. Two authors independently performed study selection, data-extraction and risk of bias assessment. In a meta-analysis, outcomes regarding treatment effects on cardiovascular risk factors (blood pressure, glycated hemoglobin A1c (HbA1C), low-density lipoprotein (LDL) cholesterol, smoking status, weight and physical inactivity) and incident cardiovascular disease were pooled with random effects models.

Results: A total of 57 studies (N=19,862) fulfilled eligibility criteria and 47 studies contributed to the meta-analysis. A significant reduction in systolic blood pressure (mean difference -2.66 mmHg, 95% CI -3.81 to -1.52), diastolic blood pressure (mean difference -1.26 mmHg, 95% CI -1.92 to -0.60), HbA1c level (mean difference -0.13%, 95% CI -0.22 to -0.05), LDL cholesterol level (mean difference -2.18 mg/dL, 95% CI -3.96 to -0.41), weight (mean difference -1.34 kg, 95% CI -1.91 to -0.77), and an increase of physical activity (standardized mean difference 0.25, 95% CI 0.10-0.39) in the Web-based intervention group was found. The observed effects were more pronounced in studies with short (<12 months) follow-up and studies that combined the Internet application with human support (blended care). No difference in incident cardiovascular disease was found between groups (6 studies).

Conclusions: Web-based interventions have the potential to improve the cardiovascular risk profile of older people, but the effects are modest and decline with time. Currently, there is insufficient evidence for an effect on incident cardiovascular disease. A focus on long-term effects, clinical endpoints, and strategies to increase sustainability of treatment effects is recommended for future studies.

Keywords: aging; cardiovascular disease; eHealth; meta-analysis; older people; prevention; systematic review.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Prisma flowchart illustrating literature search.
Figure 2
Figure 2
Effect on systolic blood pressure (26 studies).
Figure 3
Figure 3
Effect on diastolic blood pressure (26 studies).
Figure 4
Figure 4
Effect on glycated hemoglobin (21 studies).
Figure 5
Figure 5
Effect on weight (17 studies).
Figure 6
Figure 6
Effect on low-density lipoprotein cholesterol (17 studies).
Figure 7
Figure 7
Effect on physical activity (14 studies).
Figure 8
Figure 8
Effect on cardiovascular composite scores (9 studies).
Figure 9
Figure 9
General effect on primary outcomes (37 studies).
Figure 10
Figure 10
Effect on cardiovascular event rates (6 studies).
Figure 11
Figure 11
Association between study duration and effect size (Hedges' g). One outlier study (Ideatel) was removed from analysis.
See this image and copyright information in PMC

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