Multifactorial Lifestyle Interventions in the Primary and Secondary Prevention of Cardiovascular Disease and Type 2 Diabetes Mellitus—A Systematic Review of Randomized Controlled Trials

Abstract

This systematic review aims to summarize the available randomized trials of multifactorial lifestyle interventions in the primary and secondary prevention of coronary heart disease and type 2 diabetes mellitus. Randomized trials investigating the effects of lifestyle interventions including the elements of diet, physical activity, and stress management in people at increased risk for or with manifest coronary heart disease or type 2 diabetes mellitus were searched for in five electronic database and by citation tracking. Quality was assessed using the Cochrane Collaboration's risk of bias tool. Exploratory effect size calculations were performed for a variety of laboratory and clinical outcome measures. Twenty-five trials including a total of 7,703 participants met the inclusion criteria. Fifteen trials were in patients with coronary heart disease, seven in patients with type 2 diabetes mellitus, and three on primary prevention. The interventions varied greatly regarding concept, intensity, and providers. Compared to participants in "usual care" control groups, there were no consistent effects on lipid levels and blood pressure and small effects on body mass index and glycated hemoglobin (HbA1c). Composite cardiac event rates were significantly less in the intervention groups of the few trials reporting these outcomes. Mortality was also lower in the intervention groups, but the difference was not statistically significant, and confidence intervals were wide. The evidence base for multifactorial lifestyle interventions is weak. Effects on surrogate measures seem minor, but there may be clinically relevant effects on major clinical endpoints.

Diabetes Prevention in the Real World: Effectiveness of Pragmatic Lifestyle Interventions for the Prevention of Type 2 Diabetes and of the Impact of Adherence to Guideline Recommendations

“…However, the authors only focused on translation of evidence from the U.S. Diabetes Prevention Program and also included studies where up to half of the population already had diabetes. Other systematic reviews of diabetes prevention interventions have either not included a meta-analysis (6,8,(14)(15)(16)(17) or have not focused on translational studies (3,6,15,16,(18)(19)(20)(21)(22). Overall, the systematic reviews conducted to date indicate that real-world diabetes prevention programs vary widely in their effectiveness, although most produce lower levels of weight loss than the more intensive interventions used in the clinical efficacy trials (9).…”

The Role of Physical Activity in Chronic Kidney Disease in the Presence of Diabetes Mellitus: A Prospective Cohort Study

“…Cardiovascular disease is the major cause of mortality for CKD and DM patients [33,34]. Exercise is beneficial in ameliorating cardiovascular risk factors such as hypertension, dyslipidemia, hyperglycemia, obesity, inflammation and oxidative stress [12,13,18,19]. In addition, diabetic patients have been found to have increased mortality from cancer, and exercise can substantially reduce cancer mortality [34,35].…”

“…Exercise has a beneficial influence on most disease conditions, including diabetes [12,13,14,15] and CKD [16,17,18,19,20,21,22,23]. Regular physical activity can lead to weight loss, improves blood sugar control, reduces vascular complications, increases well-being and reduces mortality in diabetic patients [12,13,14,15].…”

“…Regular physical activity can lead to weight loss, improves blood sugar control, reduces vascular complications, increases well-being and reduces mortality in diabetic patients [12,13,14,15]. Exercise has also been reported to benefit CKD patients by preserving the estimated glomerular filtration rate (eGFR), reducing proteinuria, blood pressure and blood lipids, and improving quality of life and survival [16,17,18,19,20,21,22,23].…”

Diabetes Mellitus

“…It is clear that lifestyle modifications, including dietary therapy, increased physical activity and smoking cessation, are fundamental for the management of CVD and these factors contribute to a decrease in disease incidence and mortality [41][42][43][44][45][46] . In patients with DM, dietary therapy and exercise decrease the risk of atherosclerosis, hyperglycemia, dyslipidemia and hypertension [47][48][49] .…”