This study tests the effectiveness of Neighborhood Health Worker/Nurse Case Management compared with usual care (referral to usual primary care source) for the management of coronary heart disease risk factors in African American siblings of persons with premature coronary disease. Index patients with documented coronary disease prior to 60 years of age will be recruited from 7 Baltimore hospitals to identify 480 siblings to be screened to identify those with a criterion risk factor (LDL- cholesterol greater than 130 mg/dl, blood pressure greater than 140/90 mmHg, and/or cigarette smoking) (n=433). Eligible siblings are those between 30 and 60 years of age with no known coronary disease. Siblings with criterion risk factors after screening will be randomly assigned by family to receive care in the community by a case management team consisting of a Neighborhood Health Worked guided by a nurse and cardiologist, or to receive usual care. Siblings will be followed one year after screening to determine the proportion in each group who meet goal levels of blood pressure, LDL-cholesterol, dietary fat, physical activity, and smoking cessation. The study builds on prior work in both the African American community and in siblings that shows that 1.) nurse managed care produces more successful risk reduction, 2.) African Americans accept care in the community and from Neighborhood Health Workers, and 3.) sociocultural models of care are more likely to be successful in high risk African American families. The goal is to increase the proportion of high risk siblings who achieve goals based on national guidelines. This is one of the first studies to empirically examine a combination of community intervention for multiple risk factor reduction using indigenous workers and approaches which address the needs of individuals with a documented family history of premature coronary heart disease. Analysis will include the test of proportions achieving goals and multiple logistic regression analysis predicting favorable change, adjusted for intra-family clustering of baseline risk factors.
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