Knowing your heart risk nudges behaviour change

With antiretroviral therapy, HIV has become a manageable chronic condition, and rising life expectancy means a growing number of people living with HIV are aged over 50 — bringing an increasing burden of chronic non-communicable diseases, especially cardiovascular disease. Strikingly, traditional risk factors such as smoking, drinking, inactivity and diet contribute far more to that cardiovascular risk than HIV-related factors do. That makes behavioural intervention urgent and, in principle, tractable. This trial tested whether simply warning people of their calculated heart-disease risk, paired with brief personalised coaching, could shift knowledge and behaviour.

Researchers ran a multicentre non-randomised controlled trial across six AIDS-designated hospitals in Zhejiang Province, China, with three survey rounds between January 2023 and January 2024 and assessments at baseline, 3 months and 6 months. The intervention group was informed of their 5- and 10-year cardiovascular risk, verbally or online, and received about 15 minutes of personalised risky-behaviour reinforcement, face-to-face or online; controls received only routine clinic health education. Of 948 eligible participants (average age 42.08 years, 87.13% male), 362 pairs were successfully matched using propensity scores, and generalised estimating equations assessed the intervention effect.

After 6 months, cardiovascular disease knowledge improved significantly more in the intervention group — a total increase of 2.30 points versus 0.41 points in controls (P = 0.028). The proportion of participants who almost never drink rose by 4.54% more than controls, and the proportion with more than 8 hours of daily sedentary time fell by 1.46% (both P < 0.05). The 10-year cardiovascular risk score decreased by 0.63% in the intervention group versus 0.18% in controls. Smoking and drinking rates fell more, and physical exercise compliance rose more, in the intervention group, but these differences were not statistically significant.

The study adds to evidence that personalised risk communication can raise health knowledge and nudge specific behaviours, while also illustrating the familiar gap between knowing and doing: the harder endpoints of quitting smoking or alcohol did not shift significantly. Because the trial was non-randomised, propensity-score matching reduces but cannot eliminate confounding, and the follow-up of 6 months is short for behaviour change to consolidate. Whether these small early shifts translate into fewer cardiovascular events over years remains an open question, as does how the approach would perform in other populations.

The general lesson travels beyond HIV care: being shown a concrete, personalised estimate of your own future heart-disease risk appears to sharpen knowledge and can nudge some habits, such as drinking frequency and sedentary time, in the right direction. Equally, the results are a sober reminder that a one-off warning plus brief advice rarely produces wholesale change — entrenched behaviours like smoking budged only modestly and not significantly. This is a reason to think risk awareness is a useful starting point for behaviour change, not a sufficient one.