A systematic review and meta-analysis testing the effect of lifestyle modification and medication optimization programs on cholesterol and blood pressure in patients with cardiovascular disease

BACKGROUND: Cardiovascular diseases (CVDs) are the leading cause of mortality and morbidity globally, and a number of treatment and preventive strategies have been tried for years. Lifestyle modification programs have been widely implemented as a primary prevention strategy to reduce the burden of CVDs. However, their effectiveness in patients with established CVD in monitoring modifiable risk factors is controversial and requires further investigation. METHODS: A comprehensive search was conducted in PubMed, Cochrane, Science Direct, and LILACS without date and language restrictions. All randomized controlled trials (RCT) comparing the effectiveness of lifestyle modification and/ or optimization of drug therapies among patients with established cardiovascular disease were included. The primary outcomes were changes in systolic blood pressure and low-density lipoprotein cholesterol. Secondary outcomes included changes in total cholesterol, diastolic blood pressure, and medication adherence. Meta-analysis results were reported as standardized mean difference (SMD) or risk ratio (RR) and 95% confidence intervals (CI). Sub-analyses examined programs that included both lifestyle modification and drug optimization or type of intervention alone if a minimum of three trials were identified. The quality of evidence was evaluated using GRADE and trial sequential analyses. RESULTS: Sixteen trials including 4450 participants were included in testing programs focused on both lifestyle modification and drug optimisation (seven RCTs) and lifestyle modification alone (nine RCTs). Overall the programs significantly reduced systolic blood pressure (SMD = - 0.30, 95% CI - 0.43 to - 0.17, P < 0.001), diastolic blood pressure (SMD = - 0.18, 95% CI - 0.28 to - 0.08 P < 0.001), total cholesterol (SMD = - 0.28, 95% CI - 0.49 to - 0.07, P = 0.009); however, the quality of evidence was rated as low. CONCLUSION: Lifestyle modification and medication optimization interventions had a significant effect on monitoring blood pressure and serum cholesterol; however, the provision of the firm conclusion is less optimal with current evidence as the quality of evidence was low. SYSTEMATIC REVIEW REGISTRATION: The systematic review and meta-analysis protocol was registered in PROSPERO CRD42024523078.