Background: Although healthy lifestyle behaviors have been shown to significantly reduce cardiovascular disease (CVD), offsetting even genetic risk, most CVD programs focus solely on risk scores rather than calculating health improvement. We sought to validate a newly developed quantitative composite healthy lifestyle behavioral score, the Optimal Health Impact Factor (OHIF), which captures behavioral change by attainment of thresholds established by clinical guidelines.
Methods: Patients in the Integrative Cardiac Health Project’s 12-month Registry, a prospective lifestyle change program for the prevention of CVD, underwent traditional risk assessment by a nurse practitioner. Additionally, at baseline and 12-months, OHIF scores were calculated using validated questionnaires in the following four domains: nutrition (Rate-Your-Plate), exercise (minutes of continuous exercise per week), stress (Perceived Stress Scale) and sleep (Pittsburgh Sleep Quality Index). Each domain has a gradient of three behavioral threshold scores (not at goal, red=1; almost to goal, amber=2; at goal, green=3) for a maximum of 12 possible OHIF points representing optimal health behaviors. All patients received motivational health coaching by a multidisciplinary team. Data were analyzed by t-tests, comparing measures at baseline and at 12-months.
Results: Of 225 consecutive completers (48% men, age 56.8 ± 12.9 years, 145 White, 54 Black, 26 other, 61% at high risk by family history of CVD in first order relatives), 160 (71%) showed clinically and statistically significant improvements in the four behavioral domains and selected laboratory data.
Conclusions: Improvements in healthy lifestyle behaviors captured by the OHIF score correlate significantly with improvements in critical CVD risk factors, even in a population with high genetic risk. The OHIF score emphasizes gradients of positive lifestyle behavior change for both patient and provider to facilitate development of an actionable behavioral health plan to reduce CVD. Clinicians who calculate a CVD risk score may also find clinical value in calculating a composite OHIF score as a single measurable outcome tool for tracking behavioral changes longitudinally.