We will study efficacy of diagnosis, prevention, and control of major cardiovascular disease (CVD) risk factors in coronary, carotid and peripheral vascular bypass patients less than 55 years old, and their families in a specialized intensive program compared to customary community care. Probands and their families (spouses and first degree relatives) will be randomized into 3 groups. In groups 1 and 2, CVD risk factors will be measured in probands and family members at a specialized clinic, while in group 3, diagnosis of CVD risk factors will be done by the subjects' physician. Subsequently in group 1, we will treat abnormal CVD risk factors intensively over a 2 yr period in a specialized clinic. We will send the results of our initial CVD risk factor measurements in group 2 families to the subjects' doctors. We will restudy abnormal group 2 probands and family members once per year, comparing the results of their customary therapy with that of specialized therapy in group 1. In group 3 families, both diagnosis and therapy of CVD risk factors is left to the subjects' physicians; we will, however, measure CVD risk factors in group 3 probands 2 years after randomization, in our specialized clinic. By using two control groups (#s 2 and 3), we will be able to make a number of important comparisons. We will determine diagnostic success by comparing the proportion of probands and family members in groups 1 and 2 vs group 3 who have their CVD risk factors quantitated. We will assess success or failure of treatment of CVD risk factors in families in a specialized facility (group 1), vs customary care therapy in group 2. We will compare the interaction of specialized diagnosis and treatment of CVD risk factors in group 1 families with customary diagnosis and treatment in group 3 families. We will study effects of risk factor intervention on probands' CVD morbidity and mortality in the 3 groups. We will bill subjects in groups 1, 2, and 3 for the diagnostic CHD risk factor screening tests and group 1 subjects for follow-up, so that there will be no differential costs to account for group differences. We will test for motivational-environmental reasons as to why one group may have better CVD risk factor identification/therapy than another. We should be able to provide information on within-family effectiveness, safety, and practicality of CVD risk factor diagnosis and therapy, comparing intensive demonstration approaches to customary community care, with the long range objective of improving preventive-medical approaches to CVD at the community level, reducing CVD morbidity, and improving community cardiovascular health.
