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All rights reserved. doi:10.1016/j.ijcard.2012.06.032 Behavioral changes after cardiovascular events: A cohort study Débora Luiza Franken a , Maria Teresa Anselmo Olinto a,b, ⁎, Vera Maria Vieira Paniz a , Ruth Liane Henn a , Luciene Duranti Junqueira a , Flavia Gama da Silveira a , Vania Rosa Roman a , Euler Roberto Fernandes Manenti c , Juvenal Soares Dias da Costa a a Post-graduate Program of Collective Health, University of Vale do Rio dos Sinos, São Leopoldo, Brazil b Department of Nutrition, Federal University of Health Sciences, Porto Alegre, Brazil c Institute of Vascular Medicine, Hospital Mãe de Deus, Porto Alegre, Brazil article info Article history: Received 2 June 2012 Accepted 9 June 2012 Available online 4 July 2012 Keywords: Cardiovascular Diseases Risk factors Secondary prevention Behavior Cohort studies Evidence shows that the risk of death and recurrent cardiovascular events is lower among individuals who modify their risky behavior after they experience these events. Lifestyle changes may result in improved quality of life, and protecting patients from new cardiovas- cular events [1,2]. However, which types of risky behavior are most frequently changed after occurrences of cardiovascular events have still not been well established [3–5]. The aim of this study was to assess the behavioral changes relating to modifiable risk factors among patients hospitalized due to cardiovascular disease (CVD). This was a prospective cohort study on 301 patients aged ≥ 30 years, of both sexes who were admitted to a large hospital in Southern Brazil due to cardiovascular disease. From May 29, 2009 to August 31, 2010, patients were included in the study if they were admitted into the hospital because of stable and/or unstable angina, acute myocardial infarction, stroke and/or transient ischemic attack, and were followed up for 180 days after hospital release. Information on behavioral characteristics related to modifiable risk factors was gathered during the hospital stay and 180 days after hospital release. Smoking habits (smoker, former smoker or non- smoker), alcohol consumption (daily frequency, some days per week or never/almost never), physical activity (whether any type of leisure physical activity was practiced for more than one month) and dietary habits were evaluated. Dietary habits were evaluated based on the consumption of food indicative of healthy and risky dietary habits [2,6]. Deemed as markers for “healthy dietary habits,” data on patients' consumption of fruits, greens and other vegetables (weekly frequency of consumption and number of portions consumed, transformed into number of portions/day) and fish (monthly frequency of consump- tion, transformed into weekly consumption by dividing the number of times by four) were collected. As indicators of “risky dietary habits,” the consumption of red meat and chicken (with and without apparent fat), the types of fat primarily used to prepare food and the consumption frequency per week of margarine, fried foods or processed meats were evaluated. A score was created considering the sum of points attributed to each variable, ranging from zero to eight points. For healthy dietary habits, one point was allotted to an intake of fruit, greens and other vegetables greater than or equal to the median consumption per day, as well as for fish consumption that amounted to one or more times per week. For the markers of risky dietary habits, one point was given to lower intake or when the nutrition recommendation was met [6]. An inter- mediate score (between 0.25 and 0.75) was also given to fried foods and processed meats to weight the intermediate consumption frequencies. This score was divided into terciles such that the first tercile corresponded to the least appropriate dietary habits and the third reflected the most appropriate dietary habits. Descriptive and comparative analyses initially were performed on the prevalence of behavioral variables at the time of admission and 180 days after hospital release. The McNemar chi-squared test was used to check for statistically significant differences in these variables between admission and at follow-up, with a significance level of 0.05. Statistical analyses were performed using SPSS 17.0 (Statistical Package for the Social Sciences) software. This project was approved by the Research Ethics Committee of the University of Vale do Rio dos Sinos through communication 091/2008, ⁎ Corresponding author at: Post-graduate Program of Collective Health, University of Vale do Rio dos Sinos, São Leopoldo, Brazil. Tel.: +55 51 35908752; fax: +55 51 35908479. E-mail addresses: nutdeborafk@yahoo.com.br (D.L. Franken), mtolinto@gmail.com (M.T.A. Olinto), vpvieira@terra.com.br (V.M.V. Paniz), ruthenn@unisinos.br (R.L. Henn), nut_luciene.junqueira@hotmail.com (L.D. Junqueira), flaviagama_sm@yahoo.com.br (F.G. da Silveira), vrrroman@hotmail.com (V.R. Roman), eulermanenti@gmail.com (E.R.F. Manenti), episoares@terra.com.br (J.S. Dias da Costa). 115 Letters to the Editor