Prevention and Rehabilitation Using an online, personalized program reduces cardiovascular risk factor profiles in a motivated, adherent population of participants R. Jay Widmer, MD, PhD, a Thomas G. Allison, PhD, a Brendie Keane, RN, c Anthony Dallas, MD, c Lilach O. Lerman, MD, PhD, b and Amir Lerman, MD a Rochester, MN; and Nashville, TN Background Cardiovascular disease (CVD) is the leading cause of morbidity, mortality, and cost in Western society. Employer-sponsored work health programs (WHPs) and Web-based portals for monitoring and providing guidance based on participants' health risk assessments are emerging, yet online technologies to improve CVD health in the workplace are relatively unproven. We hypothesized that an online WHP, comprehensively addressing multiple facets of CVD, can be successfully implemented and improve the health of participants. Methods A cohort of employees in Tennessee (n = 1,602) was subjected to a health risk assessment at baseline. Those who did not meet all 5 healthy benchmarks (n = 836)—body mass index, blood pressure, glucose, total cholesterol, and smoking status—were prospectively assigned to a Web-based personal health assistant and had repeat measurements taken at 90 days. Results Of those who both completed the personal health assistant program and underwent baseline plus 90-day assessments (508/836, 61%), 75% were female, mean age was 46.5 ± 11.1 years, and the mean number of risk factors at baseline was 1.1 ± 0.9 with a mean 10-year Framingham Risk Score of 2.9%. This cohort demonstrated a significant reduction in total cholesterol (P b .0001), low-density lipoprotein cholesterol (P b .0001), triglycerides (P b .0001), systolic blood pressure (P = .009), glucose (P = .004), weight (P = .001), and body mass index (P = .001). Most of the participants improved at least 1 risk factor. Framingham Risk 10-year cardiovascular risk percentages were significantly reduced (P = .003). Conclusions This study in a prospective cohort of community-dwelling employees suggests that an online WHP can provide a viable means to improve surrogates of CVD risk factors. (Am Heart J 2014;167:93-100.) Cardiovascular disease (CVD) is the primary cause for morbidity, mortality, and rising health care associated costs in the United States. Recent estimates attribute N1 in every 3 deaths to CVD 1,2 and N90% of CVD morbidity and mortality to preventable risk factors. 3 According to 2012 statistics, poor diet, smoking, and lack of physical activity continue to account for an overwhelming majority of CVD and death. 4 Recently, employers have recognized the significance of health in the workplace in an effort to improve productivity and reduce human and capital costs. Work health programs (WHPs) have become popular in the past decade showing promising results for reducing health care costs, 5 improving worker productivity, 6 and improving surrogate risk factors for CVD 7 as well as ameliorating lifestyle behaviors known to cause CVD, such as poor diet and lack of physical activity. 8 However, one of the major challenges is to entice patients to access and engage in these WHPs in concert with the reduction of CVD risk. 9 Although emergence of the Web-based solutions and social networks in health care shows promise, 10,11 these interventions are poorly integrated into standard health care with various efficacies. 12 Furthermore, no single WHP, designed in a comprehen- sive, evidence-based, and Web-based or smartphone- accessible manner, has been able to significantly affect an individual patient's composite primary prevention CVD risk factor profile in a low-risk population. Here, we prospectively follow an adherent cohort of employees as they undergo a health risk assessment at baseline and 90 days after initiating an online, interactive WHP. We hypothesized that participants who qualify for and From the a Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and College of Medicine, Rochester, MN, b Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic and College of Medicine, Rochester, MN, and c CareHere, Inc, Nashville, TN. Submitted May 14, 2013; accepted September 29, 2013. Reprint requests: Amir Lerman, MD, Division of Cardiovascular Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN 55905. E-mail: lerman.amir@mayo.edu 0002-8703/$ - see front matter © 2014, Mosby, Inc. All rights reserved. http://dx.doi.org/10.1016/j.ahj.2013.09.019