JMIR Publications

ABSTRACT

Background:

The fact that elevated levels of low-density lipoprotein cholesterol (LDL-C) were established risk factors for atherosclerotic cardiovascular disease (ASCVD) is well accepted. However, considering that low compliance to medication and lifestyle management has limited the benefits of lowering lipid levels, cognitive behavior therapy (CBT) is proposed as a solution to improve clinical outcomes.

Objective:

This trial aimed to evaluate the effectiveness of mobile-based CBT interventions in lowering LDL-C levels in ASCVD patients.

Methods:

This multicenter, prospective, randomized controlled trial (RCT) enrolled 300 ASCVD patients, randomly assigned to a mobile-based CBT intervention group and control group in a ratio of 1:1. Linear regression analysis was used to determine the effects of mobile-based CBT intervention on the changes in LDL-C, triglyceride (TG), C-reactive protein (CRP), the score of General Self-Efficacy Scale (GSEs) and Quality of Life index (QL-index). Logistic regression analysis was used to determine the effects of mobile-based CBT intervention on the up-to-standard rates of LDL-C. The exploratory subgroup analysis was further conducted.

Results:

Finally, 296 participants completed the up-to-6-month follow-up (148 in the CBT group and control group, respectively), and the baseline means LDL-C levels was 2.48±0.90 mmol/L, 21.3% up-to-standard rates for LDL-C. Linear regression analysis demonstrated that mobile-based CBT intervention significantly reduced the LDL-C level in ASCVD patients at the 6th month follow-up (β=-10.026, 95%CI: -18.111 to -1.940, P < .001). Even if the baseline LDL-C <1.8 mmol/L, CBT intervention remained favorable (β=-24.103, 95%CI: -43.110 to -5.095, P = .002). Logistic regression analysis showed that CBT intervention also moderately increased the up-to-standard rates of LDL-C in the 6th month (OR=1.579, 95%CI: 0.994 to 2.508, P = .005). Linear regression analysis also demonstrated that CBT significantly improved the score of GSEs and QL-index during the whole follow-up (P value for all<0.05).

Conclusions:

Mobile-based CBT was an effective method for long-term LDL-C level management and could immediately and effectively improve the self-efficacy and quality of life of ASCVD patients.