Discussion
CVDs, DM
ACUTE MYOCARDIAL INFARCTION, CVD, MINOR, EVENT, SECONDARY
DM can drastically increase the risk of CVDs. The INTERHEART study, which collected data from more than 27,000 subjects in 52 countries, identified DM as a strong risk factor for acute myocardial infarction (The secondary data analysis of the PreFord study shows that the cardiovascular risk of persons with pre-DM/DM can be substantially reduced through the multimodal lifestyle program applied in the study. There was a direct effect on several health variables and the ESC-SCORE after 15 weeks. Over the next 3 years of follow-up, there were more favorable results in the INT group.The ESC-SCORE reflects the probability of dying in the next 10 years from a cardiovascular event (The overall results suggest a clear positive health effect of the intervention for the subgroup studied, which is very similar to the effect for the entire study cohort group (A closer look at the long-term effects on the ESC-SCORE changes (intention-to-treat analysis) implies that pre-DM patients in particular benefited from the lifestyle intervention. Further measures may be necessary to achieve more beneficial effects in patients with manifest DM. However, it should be noted that the pre-DM patients already had higher values at the beginning of the study, so that possible improvements may be more pronounced in them than in the DM patients. However, the result should not be overestimated, as only 42% of the DM patients of the intention-to-treat analysis fully adhered to the study protocol.The strategy for raising awareness of CVD risk at the workplace through flyers and offering a quick medical check-up free of charge could—as demonstrated in the present study—motivate workers with pre-DM and DM to participate in multimodal therapy. Despite the noted drop-out rate during the intervention of 37% among those with pre-DM and DM (for all study participants, the rate was 32%), the intention-to-treat analysis nevertheless indicated significant and clinically meaningful improvements post-intervention, underscoring the program’s overall efficacy.The PreFord study has some limitations, which have already been pointed out in the initial publication (An additional point that might be of interest, especially for the secondary analysis, is that no distinction was made between the types of DM. Among the 13 insulin-dependent patients, some patients with type 1 DM may have been included. However, Juutilainen et al. (Furthermore, there was a minor, but statistically significant difference in BMI values between the INT and CON group, which might have affected the development of health values. However, for the primary outcome (ESC-SCORE), the groups were almost perfectly matched.