Although the authors assert that their study is the largest RCT of its kind, the COMPETE III investigators might suggest otherwise. Our trial randomized 1102 patients with vascular risk factors with a secondary prevention subset approximately the same size as the Verneeij study. The CIII study included an Internet vascular risk tracker for patients and a clinical care coordinator. In addition, the patient's primary care physician also had a version of the tracker linked to their electronic medical record.

Although we were able to show a significant improvement in the processes of monitoring vascular risk factors, we found no overall improvement in vascular risk, as measured by a composite score. Both studies tested complex interventions aimed at improving multiple behaviours. Although Internet-based interventions may be useful for a segment of the computer-literate population, we have not found them popular with older patients. The best combination of computer-based personalized risk factor monitoring and decision support; supportive coaching by care coordinators, family or peer volunteers; and physician management to optimize behaviour change in vascular disease, remains to be seen.

References
1. Holbrook A, Pullenayegum E, Thabane L, Troyan S, Foster G, Keshavjee K, Chan D, Dolovich L, Gerstein H, Demers C, Curnew G. Shared Electronic Vascular Risk Decision Support in Primary Care: Computerization of Medical Practices for the Enhancement of Therapeutic Effectiveness (COMPETE III) Randomized Trial. Arch Intern Med 2011;171(19):1736-1744.

Competing interests: None declared