Preliminary Study of the Cause of Persistent High Coronary Risk Status and Effect of Applying Family Partnership Intervention Program in Asymptomatic Air Force Officers

Main Article Content

Adiporn Khajonhyai, RN, MNS
Jariyawat Kompayak, PhD
Nopphanath Chumpathat, RN, PhD
Taweesak Kasiphol, RN, PhD
Roongaroon Thammalikhit, MD
Nuttira Keadtisut, RN


OBJECTIVE: Over the past three years, cardiovascular disease (CVD) hasbecome the leading cause of death among Thai military officers. Recent 10-yrcohort study in asymptomatic Air Force (AF) officers suggested that preventionof CVD was feasible by identifying high risk candidates (10-yr risk by themodified Coronary Risk Chart > 20%) for early treatment. At the same time, afailure in risk reduction could lead to catastrophic events. Most of the CVDcases, both acute coronary syndrome (ACS) and stroke, became persistent highrisk candidates for three consecutive years. This study intended to explore thecause of risk reduction failure and to reduce the risk by having family memberparticipation through the Family Partnership Intervention Program (FPIP).

MATERAIL AND METHODS: Inclusion criteria were asymptomatic maleofficers, age ranged from 35-60 years, who had persistent high coronary risk score(> 20% over 10 years) for two consecutive years despite receiving medication,had no CVD and had family members available for the FPIP. Exclusion criteriawere officers of age < 35 and > 60 years, had serious illness (such as ACS, stroke,cancer, psychological disease) and had no family members available forparticipation. A personal interview to assess pre-existing risk factors and life stylerecommendations was conducted before and after the eight weeks period of FPIP.

RESULTS: Ten AF officers (average age of 55.2 ± 5.3 years) took partvoluntarily. Most of them (70%) had a sedentary job and took prescribedmedication. The common major coronary risk factors were hypercholesterolemia(80%), hypertension (60%), diabetes mellitus (40%), and impaired fasting glucose(40%). Insufficient knowledge was the major cause of persistent high CVD riskstatus. It led to several unhealthy habits including having an atherogenic diet (highanimal fat, low fiber and sweet) 100%, exercise less than twice a week 90%,cigarette smoking 30%, self-reported mental stress 30% and poor medicalcompliance 14.2%. After 8-weeks of FPIP, 60% of candidates were able to reducetheir high risk status to the intermediate group (predicted ris 10-20%) in fivecases and to low risk group (predicted risk 5-10%) in one case. Although, serumtriglyceride and HDL cholesterol were not significantly different, totalcholesterol reduced from 224 ± 26.1 to 191 ± 30.7 mg/dl, p = 0.005, and bloodglucose decreased from 118 ± 22.0 to 103 ± 15.4, p = 0.016.

CONCLUSION: Ineffective group education and insufficient preventive knowledgeled to unhealthy life style decisions and caused persisting high CVD risk status.Individual approach by setting common goals and having family memberparticipation could reduce the predicted CVD risk in 60% of cases. The majorlimitation of the study was the small number of cases and the short term study ofonly AF officers. These results may not be applied to general population and maynot guarantee the long term outcome beyond eight weeks. However, this studywas the first one to identify the cause of persistent high CVD risk status of AFofficers and offer a better way of effective risk reduction.


Download data is not yet available.

Article Details

How to Cite
Khajonhyai A, Kompayak J, Chumpathat N, Kasiphol T, Thammalikhit R, Keadtisut N. Preliminary Study of the Cause of Persistent High Coronary Risk Status and Effect of Applying Family Partnership Intervention Program in Asymptomatic Air Force Officers. BKK Med J [Internet]. 2019Jun.26 [cited 2020Jul.16];15(1):32. Available from:
Original Article
Author Biography

Nopphanath Chumpathat, RN, PhD


Cardiovascular diseases. World health Organization News;May 2017

Division of Health Statistics Bureau of Health Policy andPlanning. Public Health Statistics AD 2007-2014, Bangkok:Office of the Permanent Secretary, Ministry of Public Health2014.

Suwanwela NC. Stroke Epidemiology in Thailand. J Stroke2014;16(1):1-7.

The annual report 2014-2016: Causes of death among thein- service Thai military officers, Army, Navy and Air Force,unpublished data.
Veerakul G, Khajornyai A, Wongkasia S, et al. Predicting andpreventing cardiovascular events in asymptomatic patients:A 10-year prospective study. BKK Med J 2017;13:1-12.

Wood D, De Backer G, Faergemann O, et al. Prevention ofcoronary heart disease in clinical practice: Recommendationsof the Second Joint Task Force of European and other Societieson coronary prevention. Eur Heart J 1998;19:1434 -503.

Veerakul G, Nootaro A, Damrongrat B, et al. Five-Year Outcomeof primary cardiovascular prevention in Air Force Officers.Asian Heart J 2012; 20;1-11.

Piepoli MF, Hoes AW, Agewall S, et al. The 2016 EuropeanGuidelines on cardiovascular disease prevention in clinicalpractice: The Sixth Joint Task Force of the European Societyof Cardiology and Other Societies on Cardiovascular DiseasePrevention in Clinical Practice (constituted by representativesof 10 societies and by invited experts) Developed with thespecial contribution of the European Association forCardiovascular Prevention & Rehabilitation (EACPR). EurHeart J 2016;37:2315-81.

Veerakul G. Coronary Risk factors and Modification. In AdairOV (ed): Cardiology Secret, 2nd ed. Hanley&Belfus,Inc.,2001;118-23.

Vartianinen E, Puska P, Pekkanen J, et al. Changes in riskfactors explain changes in mortality from ischaemic heartdisease in Finland. BMJ 1994;309:23-7.

Ford ES, Ajani UA, Croft JB, et al. Explaining the decreasein U.S. deaths from coronary disease, 1980-2000. New EnglJ Med 2007;356(23):2388-98.

Srimahachota S, Kanjanavanich R, Boonyaratavej S, et al.Demographic, Management Practices and In-HospitalOutcomes of Thai Acute Coronary Syndrome Registry(TACSR): The different from the Western World. J Med AssocThai 2007;90 (Suppl 1):1-11.
Levitzky YS, Pancina MJ, D’Agostino RB, et al. Impact ofimpair fasting glucose on cardiovascular disease; theFramingham Heart Study. J Am Coll Cardiol 2008;51(3):264-70.

Ford ES, Zhao G, Li C. Pre-diabetes and the risk ofcardiovascular disease: a systemic review of the evidence. JAm Coll Cardiol 2010;55(13):1310-7.

Myers J. Exercise and Cardiovascular Health. Circulation2003;107:e2-e5.

Gould KL, Ornish D, Kirkeeide R, et al. Improve stenosisgeometry by quantitative coronary arteriography aftervigorous risk factor modification. Am J Cardiol 1992;69(9):845-53.

Schuler G, Hambrecht R, Schlierf G, et al. Regular physicalexercise and low fat diet: effects on progression of coronaryartery disease. Circulation 1992;86:1-11.

Veerakul G, Kitkungwan T, Bhatia N. Improved angiographicfindings in a high risk acute coronary syndrome patient aftermodest weight reduction, regular exercise and medication: Acase report and literature review. BKK Med J 2012;4:50-6.

Linke A, Erbs S, Hambrecht R. Effects of exercise trainingupon endothelial function in patients with cardiovasculardisease. Front Biosci 2008;13:424-32.

Thompson PD, Buchner D, Pina IL, et al. Exercise andphysical activity in the prevention and treatment ofatherosclerotic cardiovascular disease: a statement from theCouncil on Clinical Cardiology (Subcommittee on Exercise,Rehabilitation, and Prevention) and the Council on Nutrition,Physical Activity, and Metabolism (Subcommittee onPhysical Activity). Circulation 2003;107(24):3109-16.

Kantor MA, Cullinane EM, Herbert PN, et al. Acute increasein lipoprotein lipase following prolonged exercise.Metabolism 1984;33(5):454-7.

Thompson PD, Cullinane E, Henderson LO, et al. Acute effectsof prolonged exercise on serum lipids. Metabolism1980;29(7):662-5.

Farber H, Arbetter J, SchaeVer E, et al. Acute metabolic effectsof an endurance triathlon. Ann Sports Med 1987;3:131-8.

Couillard C, Després JP, Lamarche B, et al. Effects ofendurance exercise training on plasma HDL cholesterol levelsdepend on levels of triglycerides: evidence from men of theHealth, Risk Factors, Exercise Training and Genetics(HERITAGE) Family Study. Arterioscler Thromb Vasc Biol2001;21(7):1226-32.