Cardiovascular and metabolic trajectories in men engaged in a multidimensional preventive care program: a prospective observational study

Objectives: To describe within-individual changes in cardiometabolic, functional and neuroendocrine markers between two standardized evaluations in men engaged in a structured preventive care program, and to examine transitions across clinical risk categories. Design: Prospective observational cohort study using routinely collected data; paired within-individual analyses. Setting: Single preventive health center in Paris, France, offering a standardized multidisciplinary assessment with individualized lifestyle, supplementation and, when indicated, pharmacological recommendations. Participants: 279 men aged 18 years or older with a first evaluation (CU1) between October 2022 and November 2025 and a second evaluation (CU2) by May 2026 (32.3% of 865 eligible men); median interval 13.3 months (IQR 12.0 - 15.6). No exclusion criteria were applied. Primary and secondary outcome measures: Within-individual change in continuous markers (Hodges-Lehmann estimate, 95% CI; Benjamini-Hochberg adjustment over 36 tests) and transitions across fixed clinical thresholds (paired odds ratios). Results: Median age was 51.2 years, BMI 24.5 kg/m2 and SCORE2 2.9%. Visceral adipose tissue mass decreased (delta -49 g, 95% CI -80.5 to -18.5; q=0.006), with small decreases in body mass and fat mass. Handgrip strength increased (right +2.35 kg, 1.70 to 3.00; left +1.70 kg, 1.05 to 2.30; q<0.001). HDL cholesterol increased (+3.5 mg/dL, 2.5 to 4.5; q<0.001), with decreases in the triglyceride/HDL and total/HDL ratios. Blood pressure, LDL cholesterol, fasting glucose (after adjustment), insulin, HOMA-IR, SCORE2 and salivary cortisol and DHEA did not change. The proportion of men below the grip strength reference value decreased from 60.1% to 47.6% (paired OR 0.34, 0.19 to 0.61) and with HDL cholesterol superior to 46 mg/dL from 26.7% to 16.5% (OR 0.25, 0.12 to 0.54). Conclusions: In this selected, health-engaged population of men who completed both evaluations, changes in a favorable direction were observed for handgrip strength, HDL cholesterol and visceral adiposity, whereas blood pressure, LDL cholesterol, glycemic markers and SCORE2 were stable. Without a comparison group, these changes cannot be distinguished from regression to the mean, test retest effects or secular trends.