The Effect of Non-pharmacological Exposures on Cardiovascular Outcomes in Patients with Metabolic Syndrome: A Systematic Review and Meta-Analysis

Purpose: Metabolic syndrome (MetS) patients have a higher risk of cardiovascular disease (CVD) incidence and mortality than those without MetS. The effects of non-pharmacological exposures may help improve the management of CVD. This study aimed to assess the long-term effects of non-pharmacological exposures on CVD in MetS patients through a meta- analysis of cohort and case-control studies. Methods: Searches were conducted in seven databases (PubMed, Embase, CINAHL, Cochrane, RISS, NDSL, and KoreaMed) between August 7, 2024 and December 1, 2024. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. The meta-analysis was conducted using the RevMan 5.4 program and RStudio 2022.12.0. A total of nine studies were included in the systematic review, with eight studies analyzed in the meta-analysis (PROSPERO CRD42024584658). Results: A total of nine studies were included in the systematic review, of which eight were eligible for meta-analysis to evaluate the effects of non-pharmacological exposures. Eight studies were included for meta-analysis to investigate the effect of non-pharmacological exposures. The quality of individual studies was rated “good” for eight studies and “poor” for one. Non-pharmacological exposures in MetS patients were effective in reducing CVD-related mortality (relative risk RR=0.81, 95% confidence interval CI, 0.73–0.91) and all-cause mortality (RR=0.80, 95% CI, 0.75–0.85). Conclusion: Interventions and education on non-pharmacological exposures in MetS patients are associated with reduced CVD. As evidence continues to emerge, future studies should explore the long-term effects of diet, smoking, and sleep by assessing their individual impacts on CVD outcomes in individuals with MetS.