In Reply We appreciate the interest of Chidambaram and Goh in our article.1 As they point out, our trial population included men and women (mean [SD] age, 50.6 [11.4] years) who had a moderate risk of future myocardial infarction based on their risk score and who were free of cardiovascular disease. Thus, our findings that a digital health intervention consisting of goal setting and regular email or text messages was not effective in reducing risk factors applies to this population and may not be generalizable to older South Asian individuals at higher risk, ie, with established cardiovascular disease or with a higher mean risk score. As has been seen in the TEXT ME trial,2 patients with established cardiovascular disease may “feel their risk” such that they are more motivated (because of their recent cardiac hospitalization) to make risk factor changes in response to a frequent text intervention.
Sonia S. Anand, Catherine Middleton, Scott Leear. The Effect of Digital Health Intervention on Reducing Cardiovascular Risk—Reply. JAMA Cardiol. 2017;2(3):346. doi:10.1001/jamacardio.2016.4246