Behavioral Versus Pharmacologic Strategies in Cardiovascular Prevention: A Systematic Review and Meta-analysis

Area of Science:

• Cardiovascular Disease Prevention
• Evidence-Based Medicine
• Public Health Interventions

Background:

• Cardiovascular diseases (CVDs) are the leading global cause of mortality.
• Modifiable lifestyle factors (diet, physical activity, smoking) are crucial in CVD development.
• Comparative effectiveness of lifestyle interventions vs. pharmacologic therapy for CVD prevention requires quantification.

Purpose of the Study:

• To systematically review and meta-analyze the effects of lifestyle modification versus pharmacologic therapy.
• To compare impacts on major adverse cardiovascular events (MACE), all-cause mortality, CVD mortality, and stroke incidence.
• To focus on middle-aged and older adult populations.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs) and prospective cohort studies.
• Searched databases: PubMed, Embase, Cochrane CENTRAL (up to June 2025).
• Included 21 RCTs and 11 cohort studies (N=312,645); used random-effects models for pooled risk ratios.

Main Results:

• Lifestyle interventions significantly reduced MACE (RR: 0.85), all-cause mortality (RR: 0.88), CVD mortality (RR: 0.84), and stroke (RR: 0.82).
• Combined diet and exercise programs demonstrated the greatest risk reduction (RR: 0.80).
• Results were robust across sensitivity analyses, with no evidence of publication bias.

Conclusions:

• Lifestyle modification offers cardiovascular protection equivalent to or exceeding pharmacologic therapy.
• Integrated behavioral programs, particularly diet and exercise, yield the most substantial benefits.
• Healthcare systems should prioritize structured lifestyle programs as a first-line CVD prevention strategy, complementing pharmacologic treatments.