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Lifestyle-focused text messaging improves CVD risk factors

Comment by Eugenio Greco, EACPR Prevention, Epidemiology and Population Science Section

Effect of Lifestyle-Focused Text Messaging on Risk Factor Modification in Patients With Coronary Heart Disease
A Randomized Clinical Trial
Clara K. Chow et al.
JAMA. 2015;314(12):1255-1263. doi:10.1001/jama.2015.10945.


The Authors examined the effect of a lifestyle-focused semipersonalised support program delivered by mobile phone text message on cardiovascular risk factors, to improve the underutilisation of cardiovascular disease prevention, including lifestyle modification.

They recruited 710 patients (mean age, 58 years; 82% men; 53% current smokers) with proven coronary heart disease between September 2011 and November 2013 in Sydney, Australia.

The primary end point was low-density lipoprotein cholesterol level at 6 months.
Secondary end points included systolic blood pressure, body mass index, physical activity, and smoking status.

Patients were divided into two groups: intervention group (n = 352) and control group (n=358):

  • Patients in the intervention group received 4 text messages per week for 6 months in addition to usual care. Text messages provided advice, motivational reminders, and support to change lifestyle behaviors
  • Patients in the control group received usual care.


Messages for each participant were selected from a bank of messages according to baseline characteristics (eg, smoking) and delivered via an automated computerised message management system. The program was not interactive.

At 6 months, levels of low-density lipoprotein cholesterol were significantly lower in intervention participants, as the reductions in systolic blood pressure, body mass index, significant increases in physical activity and a significant reduction in smoking.
The majority reported the text-message program to be useful (91%), easy to understand (97%), and appropriate in frequency (86%).

The Authors concluded that among patients with coronary heart disease, the use of a lifestyle-focused text messaging service compared with usual care resulted in greater improvement in cardiovascular disease risk factors.

The duration of these effects and hence whether they result in improved clinical outcomes remain to be determined.


The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology