Peer-Group Intervention for Lifestyle Change - Fifty-Fifty


The goal of the trial was to evaluate a comprehensive lifestyle peer-group intervention compared with control among subjects with cardiovascular risk factors.

Contribution to the Literature: The Fifty-Fifty trial showed that a comprehensive lifestyle peer-group intervention was effective at improving cardiovascular risk factor control.

Study Design

  • Randomized
  • Parallel

Individuals with cardiovascular risk factors were randomized to a comprehensive lifestyle peer-group intervention (n = 277) versus self-management control (n = 266). The intervention group had monthly meetings for 60-90 minutes per session with a peer-elected leader.

  • Total number of enrollees: 543
  • Duration of follow-up: 12-month intervention and one additional year of follow-up
  • Mean patient age: 42 years
  • Percentage female: 71%

Inclusion criteria:

Patients ages 25-50 years with:

  • Overweight (body mass index ≥25 kg/m2) or
  • Physical inactivity or
  • Smoking or
  • Hypertension (≥140/90 mm Hg)

Exclusion criteria:

  • Pregnancy
  • Chronic liver or renal disease

Principal Findings:

The primary outcome was the change in the Fuster-BEWAT score at 1 year. In the Fuster-BEWAT score, 0-3 points are assigned for each variable; Blood pressure, Exercise, Weight, Alimentation, and Tobacco. A higher score correlates with better control of risk factors.

In the intervention group, the overall mean Fuster-BEWAT score was 8.41 at baseline and 8.84 at 1 year. In the control group, the overall mean Fuster-BEWAT score was 8.34 at baseline and 8.17 at 1 year (difference between groups = 0.77, p = 0.02).

Secondary outcomes:

  • Attrition rate: 16%
  • Smoking mean Fuster-BEWAT score: difference between groups = 0.24 for intervention vs. control (p = 0.003)
  • All other risk factors, except weight: Nonsignificant benefit favoring intervention vs. control
  • For weight: No mean difference between intervention vs. control


Among individuals with cardiovascular risk factors, a comprehensive lifestyle peer-group intervention improved overall control of cardiovascular risk factors compared with self-management. The largest benefit from intervention was in smoking cessation. Future studies are needed to determine if such an intervention program can reduce long-term adverse cardiac events in a cost-effective manner.


Gómez E, Fernández-Alvira JM, Vilanova M, et al. A Comprehensive Lifestyle Peer-Group-Based Intervention on Cardiovascular Risk Factors: The Randomized Controlled Fifty-Fifty Program. J Am Coll Cardiol 2015;Nov 9:[Epub ahead of print].

Editorial Comment: Rodriguez F, Harrington RA. The Role of Peer Support in Attaining Ideal Cardiovascular Health: Peer Pressure and Prevention. J Am Coll Cardiol 2015;Nov 9:[Epub ahead of print].

Presented by Dr. Valentin Fuster at the American Heart Association Scientific Sessions, Orlando, FL, November 9, 2015.

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Exercise, Hypertension, Smoking

Keywords: Blood Pressure, Body Weight, Cardiovascular Diseases, Exercise, Hypertension, Life Style, Metabolic Syndrome X, Overweight, Peer Group, Primary Prevention, Risk Factors, Smoking, Smoking Cessation, AHA Annual Scientific Sessions

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