Case Report

The Lifestyle-Medicine Approach to CHD Risks in A Brazilian Community Study. Determining Factors and Effectiveness of Lifestyle Modification Protocol

Authors: Burini RC, Ferreira RR, Sardinha PIR, Mutran TMJ, Hanai AT, Sousa ACC, Burini FHP.

DOI: 10.33425/2639-8486.1220

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Abstract

In the last decades, CHD, among others NCDs, is leading the causes of mortality. By using the Framingham Score (FS), in our Brazilian Dynamic Cohort Study survey (n=1067), 32.4% presented some risk of CHD, mostly moderate (75.8%), and 18.3% CHD-high risk. Assessment tools included the IPAQ (long version), Healthy Eating Index (HEI-through 24-hour food intake recall), body weight, height, and electrical bioimpedance, as well as clinical signs and fasting plasma markers of insulin resistance (HOMA-IR), inflammatory (hsCRP), and oxidative (MDA) states. Having FS as main variable and as co-variables: socio-demographic, behavioral (dietetic and physical fitness) anthropometric, clinical and biochemistry, the cross-sectional analysis showed the incremental risk of CHD as being determined by older aging, lower schooling, total body (BMI) and abdominal fatness (WC and ASD) dystrophies, low-muscle mass, blood hypertension, atherosclerotic dyslipidemia and stress markers of inflammation, oxidative stress and insulin resistance. Behavioral factors of inadequate dietary quality (HEI) and physical inactivity (IPAQ) were considered weaker factors for contrasting higher risk of CHD from the other classes, differently of low VO2max, considered a strong risk factor. From that, a sub-sample (n=567) was submitted to a longitudinal intervention with lifestyle-change protocol (LiSM) with supervised physical exercises and dietary counseling. The intervention normalized the leisure domain and the total IPAQ, increased Vo2max, HEI, and muscle mass, reduced obesity and most other NCDs along with their underlying factors of inflammation and oxidative stress. Framingham score decreased, as did the prevalence of CHD-risk classes, but keeping the sample-CHD-risk (8.25% to 7.70%). These results could be amplified under higher adherence of patients to the whole lifestyle-reeducation procedures, higher compliance to longer-lasting LiSM, and by teaching the medical and health care communities to more incorporate knowledge into the daily practices of (lifestyle) medicine. The Lifestyle-, Medicine approach proposed here, would be then, an effective and moneysaving alternative to the current homeostasis approach, for the CVDs 2nd care.

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