This study represents a trial of a nursing intervention versus """"""""usual"""""""" care administered through the primary provider system with the major goal of lowering cardiovascular risk factors in asymptomatic siblings of people with premature coronary disease. The nursing intervention is based on a problem-solving framework which directs behavior change through repeated problem-solving tasks in a clinical setting. The study is designed as a randomized trial of nurse-mediated interventions for hyperlipidemia, hypertension and cigarette smoking which are based on standardized medical treatment placed in the context of an adherence-oriented problem-solving set of encounters with a nurse practitioner. Following an extensive risk factor screening of 550 asymptomatic siblings of index cases hospitalized for coronary disease, the approximately 350 resulting eligible siblings with risk factors will be randomly assigned to the nursing intervention group or a usual care group and followed for outcome evaluation at 1 and 2 years. The major outcomes will be achievement of nationally recognized goal levels of cholesterol and blood pressure, and smoking cessation. Statistical analysis will focus on the proportion in each group who achieve these goals at the follow-up periods. In addition, multiple logistic regression analysis will be performed to determine the best set of predictors of risk factor goal attainment in the overall group. Specific elements of the social-problem solving framework will be examined within the nursing intervention group to determine their impact on two related health behaviors, compliance with a Step One Diet and compliance with an exercise prescription. This study is significant because of the lack of prior intervention studies specifically in high risk families who represent the major burden of premature coronary disease in the U.S.
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