Abstract
Background: Cardiovascular diseases (CVD) remain the leading cause of global mortality, especially in individuals with comorbidities like type II diabetes and hypertension. While pharmacological therapies are vital, lifestyle interventions may offer additional benefits in reducing CVD risk. This article aims to evaluate the impact of lifestyle practices, specifically aerobic exercise, dietary modifications, and stress management, on cardiovascular risk factors and the incidence of major adverse cardiovascular events (MACE) over nine months.
Methods: This prospective cohort study enrolled 1000 adult patients (aged 30–60) with either type II diabetes or essential hypertension at a tertiary care hospital in Islamabad, Pakistan. Participants were categorized into two groups based on lifestyle adherence: (1) the exposed group, comprising individuals who regularly engaged in aerobic exercise and received dietary and psychological counseling, and (2) the non-exposed group, who did not adopt such practices. Baseline and 9-month follow-up data were collected on BMI, blood pressure, lipid profile, HbA1c, and incidence of MACE.
Results: Participants in the exposed group demonstrated significantly greater reductions in BMI, systolic/diastolic blood pressure, LDL, and HbA1c, and significantly higher increases in HDL (p<0.01). MACE incidence was 0.4\% in the exposed group versus 4.8\% in the non-exposed group. Correlation analysis showed significant associations between BMI, blood pressure, HbA1c, lipid levels, and MACE.
Conclusion: Combining lifestyle interventions with pharmacologic therapy can significantly improve cardiovascular outcomes in high-risk patients. Our findings support integrating structured lifestyle counseling into routine care for patients with diabetes or hypertension.
References
1. Jagannathan R, Patel SA, Ali MK, Narayan KMV. Global Updates on Cardiovascular Disease Mortality Trends and Attribution of Traditional Risk Factors. Current diabetes reports. 2019: 44 [PMID: 31222515, https://doi.org/10.1007/s11892-019-1161-2]
2. Mozaffarian D, Wilson PW, Kannel WB. Beyond established and novel risk factors: lifestyle risk factors for cardiovascular disease. Circulation. 2008: 3031 [PMID: 18541753, https://doi.org/10.1161/CIRCULATIONAHA.107.738732]
3. Collaborators GBDF. Burden of disease scenarios for 204 countries and territories, 2022-2050: a forecasting analysis for the Global Burden of Disease Study 2021. Lancet (London, England). 2024: 2204 [PMID: 38762325, https://doi.org/10.1016/S0140-6736(24)00685-8]
4. Ghodeshwar GK, Dube A, Khobragade D. Impact of Lifestyle Modifications on Cardiovascular Health: A Narrative Review. Cureus. 2023: e42616 [PMID: 37641769, https://doi.org/10.7759/cureus.42616]
5. Amare F, Alemu Y, Enichalew M, Demilie Y, Adamu S. Effects of aerobic, resistance, and combined exercise training on body fat and glucolipid metabolism in inactive middle-aged adults with overweight or obesity: a randomized trial. BMC sports science, medicine & rehabilitation. 2024: 189 [PMID: 39261968, https://doi.org/10.1186/s13102-024-00982-7]
6. Jiang X, Alnoud MAH, Ali H, Ali I, Hussain T, Khan MU, Khan SU, Khan MS, Khan SU, Ur Rehman K, Safhi AY, Alissa M. Heartfelt living: Deciphering the link between lifestyle choices and cardiovascular vitality. Current problems in cardiology. 2024: 102397 [PMID: 38232921, https://doi.org/10.1016/j.cpcardiol.2024.102397]
7. Karwa V, Wanjari A, Kumar S, Dhondge RH, Patil R, Kothari M. Optimizing Cardiovascular Health: A Comprehensive Review of Risk Assessment Strategies for Primary Prevention. Cureus. 2024: e66341 [PMID: 39246950, https://doi.org/10.7759/cureus.66341]
8. Polemiti E, Baudry J, Kuxhaus O, Jager S, Bergmann MM, Weikert C, Schulze MB. BMI and BMI change following incident type 2 diabetes and risk of microvascular and macrovascular complications: the EPIC-Potsdam study. Diabetologia. 2021: 814 [PMID: 33452586, https://doi.org/10.1007/s00125-020-05362-7]
9. Gray N, Picone G, Sloan F, Yashkin A. Relation between BMI and diabetes mellitus and its complications among US older adults. Southern medical journal. 2015: 29 [PMID: 25580754, https://doi.org/10.14423/SMJ.0000000000000214]
10. Owusu Adjah ES, Ray KK, Paul SK. Ethnicity-specific association of BMI levels at diagnosis of type 2 diabetes with cardiovascular disease and all-cause mortality risk. Acta diabetologica. 2019: 87 [PMID: 30167871, https://doi.org/10.1007/s00592-018-1219-7]
11. Liu X, Liu P. Body Mass Index and Major Adverse Cardiovascular Events: A Secondary Analysis Based on a Retrospective Cohort Study. Medical science monitor : international medical journal of experimental and clinical research. 2020: e919700 [PMID: 31923172, https://doi.org/10.12659/MSM.919700]
12. Freisling H, Viallon V, Lennon H, Bagnardi V, Ricci C, Butterworth AS, Sweeting M, Muller D, Romieu I, Bazelle P, Kvaskoff M, Arveux P, Severi G, Bamia C, Kuhn T, Kaaks R, Bergmann M, Boeing H, Tjonneland A, Olsen A, Overvad K, Dahm CC, Menendez V, Agudo A, Sanchez MJ, Amiano P, Santiuste C, Gurrea AB, Tong TYN, Schmidt JA, Tzoulaki I, Tsilidis KK, Ward H, Palli D, Agnoli C, Tumino R, Ricceri F, Panico S, Picavet HSJ, Bakker M, Monninkhof E, Nilsson P, Manjer J, Rolandsson O, Thysell E, Weiderpass E, Jenab M, Riboli E, Vineis P, Danesh J, Wareham NJ, Gunter MJ, Ferrari P. Lifestyle factors and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study. BMC medicine. 2020: 5 [PMID: 31918762, https://doi.org/10.1186/s12916-019-1474-7]
13. Bergmark BA, Scirica BM, Steg PG, Fanola CL, Gurmu Y, Mosenzon O, Cahn A, Raz I, Bhatt DL, Investigators S-T. Blood pressure and cardiovascular outcomes in patients with diabetes and high cardiovascular risk. European heart journal. 2018: 2255 [PMID: 29394350, https://doi.org/10.1093/eurheartj/ehx809]
14. Turgeon RD, Koshman SL, Youngson E, Pearson GJ. Association Between Hemoglobin A1c and Major Adverse Coronary Events in Patients with Diabetes Following Coronary Artery Bypass Surgery. Pharmacotherapy. 2020: 116 [PMID: 31883378, https://doi.org/10.1002/phar.2359]
15. Yap J, Anbalakan K, Tay WT, Ting D, Cheung CY, Sabanayagam C, Cheng CY, Wong TY, Yeo KK. Impact of type 2 diabetes and microvascular complications on mortality and cardiovascular outcomes in a multiethnic Asian population. BMJ open diabetes research & care. 2021: [PMID: 34244217, https://doi.org/10.1136/bmjdrc-2020-001413]
16. Wang X, Pei J, Zheng K, Hu X. High-density lipoprotein cholesterol levels are associated with major adverse cardiovascular events in male but not female patients with hypertension. Clin Cardiol. 2021: 723 [PMID: 33786851, https://doi.org/10.1002/clc.23606]
17. Ray KK, Ginsberg HN, Davidson MH, Pordy R, Bessac L, Minini P, Eckel RH, Cannon CP. Reductions in Atherogenic Lipids and Major Cardiovascular Events: A Pooled Analysis of 10 ODYSSEY Trials Comparing Alirocumab With Control. Circulation. 2016: 1931 [PMID: 27777279, https://doi.org/10.1161/CIRCULATIONAHA.116.024604]
18. Fiuza-Luces C, Santos-Lozano A, Joyner M, Carrera-Bastos P, Picazo O, Zugaza JL, Izquierdo M, Ruilope LM, Lucia A. Exercise benefits in cardiovascular disease: beyond attenuation of traditional risk factors. Nature reviews Cardiology. 2018: 731 [PMID: 30115967, https://doi.org/10.1038/s41569-018-0065-1]
19. Galan AI, Palacios E, Ruiz F, Diez A, Arji M, Almar M, Moreno C, Calvo JI, Munoz ME, Delgado MA, Jimenez R. Exercise, oxidative stress and risk of cardiovascular disease in the elderly. Protective role of antioxidant functional foods. BioFactors (Oxford, England). 2006: 167 [PMID: 17012773, https://doi.org/10.1002/biof.5520270115]
20. Feingold KR. The Effect of Diet on Cardiovascular Disease and Lipid and Lipoprotein Levels. In: Feingold KR, Ahmed SF, Anawalt B, Blackman MR, Boyce A, Chrousos G, Corpas E, de Herder WW, Dhatariya K, Dungan K, Hofland J, Kalra S, Kaltsas G, Kapoor N, Koch C, Kopp P, Korbonits M, Kovacs CS, Kuohung W, Laferrere B, Levy M, McGee EA, McLachlan R, Muzumdar R, Purnell J, Rey R, Sahay R, Shah AS, Singer F, Sperling MA, Stratakis CA, Trence DL, Wilson DP, editors. Endotext. South Dartmouth (MA): MDText.com, Inc. Copyright © 2000-2022, MDText.com, Inc.; 2000.

This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2025 ASIDE Internal Medicine