A Comprehensive Lifestyle Peer Group–Based Intervention on Cardiovascular Risk Factors: The Randomized Controlled Fifty-Fifty Program

Emilia Gómez-Pardo, Juan Miguel Fernández-Alvira, Marta Vilanova, Domingo Haro, Ramona Martínez, Isabel Carvajal, Vanesa Carral, Carla Rodríguez, Mercedes de Miguel, Patricia Bodega, Gloria Santos-Beneit, Jose Luis Peñalvo, Iñaki Marina, Napoleón Pérez-Farinós, Marian Dal Re, Carmen Villar, Teresa Robledo, Rajesh Vedanthan, Sameer Bansilal, Valentin Fuster

Research output: Contribution to journalArticlepeer-review

88 Scopus citations


Background Cardiovascular diseases stem from modifiable risk factors. Peer support is a proven strategy for many chronic illnesses. Randomized trials assessing the efficacy of this strategy for global cardiovascular risk factor modification are lacking. Objectives This study assessed the hypothesis that a peer group strategy would help improve healthy behaviors in individuals with cardiovascular risk factors. Methods A total of 543 adults 25 to 50 years of age with at least 1 risk factor were recruited; risk factors included hypertension (20%), overweight (82%), smoking (31%), and physical inactivity (81%). Subjects were randomized 1:1 to a peer group–based intervention group (IG) or a self-management control group (CG) for 12 months. Peer-elected leaders moderated monthly meetings involving role-play, brainstorming, and activities to address emotions, diet, and exercise. The primary outcome was mean change in a composite score related to blood pressure, exercise, weight, alimentation, and tobacco (Fuster-BEWAT score, 0 to 15). Multilevel models with municipality as a cluster variable were applied to assess differences between groups. Results Participants’ mean age was 42 ± 6 years, 71% were female, and they had a mean baseline Fuster-BEWAT score of 8.42 ± 2.35. After 1 year, the mean scores were significantly higher in the IG (n = 277) than in the CG (n = 266) (IG mean score: 8.84; 95% confidence interval (CI): 8.37 to 9.32; CG mean score: 8.17; 95% CI: 7.55 to 8.79; p = 0.02). The increase in the overall score was significantly larger in the IG compared with the CG (difference: 0.75; 95% CI: 0.32 to 1.18; p = 0.02). The mean improvement in the individual components was uniformly greater in the IG, with a significant difference for the tobacco component. Conclusions The peer group intervention had beneficial effects on cardiovascular risk factors, with significant improvements in the overall score and specifically on tobacco cessation. A follow-up assessment will be performed 1 year after the final assessment reported here to determine long-term sustainability of the improvements associated with peer group intervention.

Original languageEnglish
Pages (from-to)476-485
Number of pages10
JournalJournal of the American College of Cardiology
Issue number5
StatePublished - 9 Feb 2016


  • cardiovascular risk
  • healthy lifestyle
  • motivation
  • peer education


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