Healthy lifestyle changes favourably affect common carotid intima-media thickness: the Healthy Lifestyle Community Programme (cohort 2)

Abstract

Common carotid intima-media thickness (ccIMT) progression is a risk marker for cardiovascular disease (CVD), whereas healthy lifestyle habits are associated with lower ccIMT. The objective of the present study was to test whether a healthy lifestyle intervention can beneficially affect ccIMT progression. A community-based non-randomised, controlled lifestyle intervention was conducted, focusing on a predominantly plant-based diet (strongest emphasis), physical activity, stress management and social health. Assessments of ccIMT were made at baseline, 6 months and 1 year. Participants had an average age of 57 years and were recruited from the general population in rural northwest Germany (intervention: n 114; control: n 87). From baseline to 1 year, mean ccIMT significantly increased in both the intervention (0⋅026 [95 % CI 0⋅012, 0⋅039] mm) and control group (0⋅045 [95 % CI 0⋅033, 0⋅056] mm). The 1-year trajectory of mean ccIMT was lower in the intervention group (P = 0⋅022; adjusted for baseline). In a subgroup analysis with participants with high baseline mean ccIMT (≥0⋅800 mm), mean ccIMT non-significantly decreased in the intervention group (-0⋅016 [95 % CI -0⋅050, 0⋅017] mm; n 18) and significantly increased in the control group (0⋅065 [95 % CI 0⋅033, 0⋅096] mm; n 12). In the subgroup, the 1-year trajectory of mean ccIMT was significantly lower in the intervention group (between-group difference: -0⋅051 [95 % CI -0⋅075, -0⋅027] mm; P < 0⋅001; adjusted for baseline). The results indicate that healthy lifestyle changes may beneficially affect ccIMT within 1 year, particularly if baseline ccIMT is high.

Keywords: Cardiovascular disease; Cardiovascular health; Cardiovascular prevention; Carotid intima-media thickness; Lifestyle medicine; Plant-based diet; Preventive medicine.

Fig. 1.

Flowchart of participants through the study.

Fig. 2.

1-year mean and max ccIMT trajectories. Values are means and 95 % confidence intervals (adjusted for baseline). Whole group: (a and d) (IN: n 71; CON: n 55); subgroup with baseline mean ccIMT <0⋅8 mm: (b and e) (IN: n 53; CON: n 43); subgroup with baseline mean ccIMT ≥0⋅8 mm: (c and f) (IN: n 18; CON: n 12); P-values for between-group difference in 1-year trajectories of ccIMT (by ANCOVA; adjusted for baseline): (a) P = 0⋅022; (b) P = 0⋅970; (c) P < 0⋅001; (d) P = 0⋅117; (e) P = 0⋅965; (f) P = 0⋅023. ccIMT, common carotid intima-media thickness; IN, intervention group; CON, control group.