The Effect of Different Interventions for Lifestyle Modifications on the Number of Diagnostic Criteria and Clinical Aspects of Metabolic Syndrome.

Background: Lifestyle intervention programs comprise the first-choice therapy to reduce the cardiovascular risk factors in metabolic syndrome (MetS). Our aim was to compare the effects of three lifestyle modification programs on the number of diagnostic criteria and clinical parameters of MetS. Methods: Twelve-week clinical trial, including 125 adults who presented at least three of the criteria defined by the revised NCEP ATP III (National Cholesterol Education Program Adult Panel III) for MetS. Individuals were randomized into three multidisciplinary intervention groups: Standard Intervention (SI), Group Intervention (GI) and Individual Intervention (II). Results: Seventy-one individuals, aged 34-59 years, concluded the study: SI: 20, GI: 25, and II: 26. The GI and II groups presented a significant decrease of body mass index, abdominal circumference, diastolic and systolic arterial pressure after intervention. The number of diagnostic criteria for MetS decreased significantly. Within the GI and II groups, 16.0% and 15.4% of the individuals, respectively, did not meet the criteria for the clinical condition studied at the end of the interventions. In the II group, the percentage of individuals with five criteria reduced 83.5%. In the GI group, the percentage of individuals with five criteria remained the same, but the number of individuals with four criteria presented a 50.0% reduction. Conclusions: Results reinforce that nonpharmacological strategies for changing lifestyle affect the reduction of cardiovascular risk factors existing in MetS. They are also able to remove the population from this clinical condition by decreasing the diagnostic criteria. II or GI lead to a successful treatment of MetS, especially when conducted by multidisciplinary team. Brazilian Registry of Clinical Trials-ReBEC number: RBR-9wz5fc.

Melhora do estilo de vida reduz o índice de Castelli 1 em indivíduos com síndrome metabólica / Lifestyle improvement reduces Castelli 1 index in people with metabolic syndrome

Avaliar o efeito de diferentes intervenções para modificação do estilo de vida sobre o Índice de Castelli 1 em indivíduos com síndrome metabólica. Tratou-se de uma subanálise de um ensaio clínico randomizado. Foram incluídos no estudo indivíduos com diagnóstico de síndrome metabólica e idade entre 30 e 59 anos, que foram posteriormente randomizados em três diferentes grupos de intervenção. Foram realizadas avaliações antropométricas e bioquímicas no início do estudo e ao final dos três meses de intervenção. Participaram do estudo 59 indivíduos. Os modelos de intervenção realizados nos grupos intervenção individual e intervenção em grupo foram eficazes na redução significativa do índice de Castelli 1, com variância absoluta de -0,70 e -0,23, respectivamente. O modelo de intervenção padrão não demonstrou redução favorável. As intervenções que contemplaram acompanhamento multiprofissional produziram efeito benéfico na redução do índice de Castelli 1 em pacientes com síndrome metabólica.

The effect of different interventions for lifestyle modification on Castelli I Index in people with metabolic syndrome is evaluated. It is a sub-analysis of a randomized clinical assay. People with metabolic syndrome, aged between 30 and 59 years old, were included and later divided, at random, into three different intervention groups. Anthropometric and biochemical evaluations of 59 people were performed at the start and at the end of the three months of intervention. Intervention models undertaken in individual intervention groups and intervention in groups were efficient to significantly reduce Castelli 1 Index, with absolute variance of -0.70 and -0.23, respectively. Standard intervention model did not reveal favorable reduction. Interventions that underscored multiprofessional following up produced beneficent effect on the reduction of Castelli 1 Index in patients with metabolic syndrome.

SALIVARY CORTISOL AND METABOLIC SYNDROME COMPONENT'S ASSOCIATION.

BACKGROUND: Actually the lifestyle exposes the population to several risk factors related to alimentary habits and less physical activity that contributes to chronic diseases appearance worldwide. AIM: To analyze the association between salivary cortisol and the components of metabolic syndrome. METHODS: This is a cross-sectional study. As part of it, 28 individuals aged 30-59 years presenting three or more of the following findings: CA: ≥88 cm for women and ≥102 cm for men; SBP>130 mmHg and DBP>85 mmHg; GL>100 mg/dl; TG>150 mg/dl; HDL<40 mg/dl for men and <50 mg/dl for women. Was performed analysis of salivary cortisol (by radioimmunoassay) from 25 salivary samples collected throughout the day, for evaluating changes in the circadian rhythm of this hormone (8AM, noon and 8PM). RESULTS: 28 evaluated individuals had a mean age of 51.9±7.5 years, mostly women (64.3%) and a mean of BMI 33.6±3.2 kg/m². The cortisol level from the 8AM averaged 18.7±4.8 ng/dlL. Individuals with FPG>110mg/dl, have significantly lower average levels of cortisol than ones with FPG <110 (12.8±5,2 vs. 17.3±4.2). Significant correlations were HOMA vs. WC (r=0,465; p˂0,005) and TG (r=0,473; p˂0,005), WC vs. FG (r=0,446; p˂0,005) and BMI (r=0,730; p˂0.0001); TG vs. HDL (r=0,441 p˂0,005) and FG (r=0,440; p˂0,005). CONCLUSION: Morning salivary cortisol in subjects with chronically elevated blood glucose can represent a downregulation of the hypothalamic-pituitary adrenal axis. This is an important finding not yet well investigated.

Salivary cortisol and metabolic syndrome component's association / Associação do cortisol salivar com os componentes da síndrome metabólica

ABSTRACT Background: Actually the lifestyle exposes the population to several risk factors related to alimentary habits and less physical activity that contributes to chronic diseases appearance worldwide. Aim: To analyze the association between salivary cortisol and the components of metabolic syndrome. Methods: This is a cross-sectional study. As part of it, 28 individuals aged 30-59 years presenting three or more of the following findings: CA: ≥88 cm for women and ≥102 cm for men; SBP>130 mmHg and DBP>85 mmHg; GL>100 mg/dl; TG>150 mg/dl; HDL<40 mg/dl for men and <50 mg/dl for women. Was performed analysis of salivary cortisol (by radioimmunoassay) from 25 salivary samples collected throughout the day, for evaluating changes in the circadian rhythm of this hormone (8AM, noon and 8PM). Results: 28 evaluated individuals had a mean age of 51.9±7.5 years, mostly women (64.3%) and a mean of BMI 33.6±3.2 kg/m². The cortisol level from the 8AM averaged 18.7±4.8 ng/dlL. Individuals with FPG>110mg/dl, have significantly lower average levels of cortisol than ones with FPG <110 (12.8±5,2 vs. 17.3±4.2). Significant correlations were HOMA vs. WC (r=0,465; p˂0,005) and TG (r=0,473; p˂0,005), WC vs. FG (r=0,446; p˂0,005) and BMI (r=0,730; p˂0.0001); TG vs. HDL (r=0,441 p˂0,005) and FG (r=0,440; p˂0,005). Conclusion: Morning salivary cortisol in subjects with chronically elevated blood glucose can represent a downregulation of the hypothalamic-pituitary adrenal axis. This is an important finding not yet well investigated.

RESUMO Racional: Atualmente o estilo de vida expõe a população a diversos fatores de risco relacionados a hábitos alimentares e à inatividade física, contribuindo para o surgimento de doenças crônicas. Objetivo: Analisar a associação entre o cortisol salivar e os componentes da síndrome metabólica. Métodos: Estudo transversal com 28 indivíduos, idade entre 30 e 59 anos apresentando três ou mais dos seguintes achados: circunferência abdominal ≥88 cm (mulheres) e ≥102 cm (homens); pressão arterial sistólica >130 mmHg e pressão arterial diastólica >85 mmHg; glicemia >100 mg/dl; triglicerídeo >150 mg/dl; lipoproteína de alta densidade <40 mg/dl (homens) e <50 mg/dl (mulheres). Foram realizadas coletas do cortisol salivar nos seguintes horários 8 h, 12 h e 20 h e analisadas por radioimunoensaio. Resultados: A média de idade foi 51,9±7,5 anos, 64,3% eram mulheres e a média do índice de massa corporal foi 33,6±3,2 kg/m². O nível de cortisol salivar às 8 h teve média de 18,7±4,8 ng/dl. Os indivíduos com glicemia de jejum >110 mg/dl, apresentaram níveis médios de cortisol significativamente menores que os com glicemia de jejum <110 mg/dl (12,8±5,2 vs. 17,3±4,2). As correlações significativas foram HOMA vs. circunferência abdominal (r=0,465; p˂0,005) e triglicerídeos (r=0,473; p˂0,005), circunferência abdominal vs. glicemia de jejum (r=0,446; p˂0,005) e índice de massa corporal (r=0,730; p˂0,0001), triglicerídeos vs. lipoproteína de alta densidade (r=0,441 p˂0,005) e glicemia de jejum (r=0,440; p˂0,005). Conclusão: O cortisol salivar pela manhã, em indivíduos com glicemia cronicamente elevada, pode representar uma contraregulação do eixo hipotálamo-hipófise-adrenal, sendo achado importante e pouco investigado.

Hypertriglyceridemic waist (EWET), glycidic and lipid profile in patients with newly diagnosed heart attack / Cintura hipertrigliceridémica (CHT), perfil glicídico y lípidos en pacientes con nuevo diagnóstico de infarto

Introduction: hypertriglyceridemic waist phenotype (EWET) has been poorly tested in patients with established cardiovascular disease. Objectives: to evaluate a possible association between EWET, glycidic and lipid profile in patients with newly diagnosed heart attack (HA). Methods: cross-sectional study among 45 inpatients with myocardial infarction. Lipid profile (total cholesterol, HDL-c, LDL-c, serum triglycerides, TC/HDL-c ratio, non-HDL cholesterol) and glycidic profile (fasting glucose, serum insulin, glycated hemoglobin, HOMA-IR, glucose/insulin ratio) were obtained. Weight, height and waist circumferences (WC) were assessed; BMI and EWET were calculated. Analysis of Covariance Models (ANCOVA) was used to assess the objectives. Results: mean age of participants was 58.75 ± 12.41 years and 55.6% (n = 25) were men. After adjustment for age, gender and BMI, EWET was significantly associated with lower HDL-c (p = 0.02), higher TC/HDL-c ratio (p = 0.003) and a trend toward fasting glucose (p = 0.11). Conclusion: EWET phenotype seems to be associated with a worse lipidic profile in patients with newly diagnosed HA (AU)

Introducción: el fenotipo de la cintura hipertrigliceridémica (CHT) ha sido poco estudiado en pacientes con enfermedad cardiovascular establecida. Objetivos: evaluar la posible asociación entre el CHT, el perfil glicídico y los lípidos en pacientes con nuevo diagnóstico de infarto. Métodos: estudio transversal en 45 pacientes con infarto de miocardio. Se obtuvieron los lípidos (colesterol total, HDL-c, LDL-c, triglicéridos séricos, relación CT/ HDL-c, colesterol no-HDL) y el perfil glicídico (glucosa, insulina sérica, hemoglobina glucosilada, HOMA-IR, relación glucosa/insulina). Fueron evaluados peso, talla y circunferencia de la cintura (CC); se calcularon el IMC y el CHT. Se utilizó el análisis de los modelos de covarianza (ANCOVA) para evaluar los objetivos. Resultados: la media de edad de los participantes fue de 58,75 ± 12,41 años, y el 55,6% (n = 25) eran hombres. Tras ajustar por edad, sexo y el IMC, el CHT se asoció significativamente con una menor HDL-c (p = 0,02), mayor relación CT/HDL-c (p = 0,003) y una tendencia hacia la glucosa en ayunas (p = 0,11). Conclusión: el fenotipo CHT parece estar asociado con un peor perfil lipídico en pacientes con diagnóstico reciente de infarto (AU)

HYPERTRIGLYCERIDEMIC WAIST (EWET), GLYCIDIC AND LIPID PROFILE IN PATIENTS WITH NEWLY DIAGNOSED HEART ATTACK.

INTRODUCTION: hypertriglyceridemic waist phenotype (EWET) has been poorly tested in patients with established cardiovascular disease. OBJECTIVES: to evaluate a possible association between EWET, glycidic and lipid profile in patients with newly diagnosed heart attack (HA). METHODS: cross-sectional study among 45 inpatients with myocardial infarction. Lipid profile (total cholesterol, HDL-c, LDL-c, serum triglycerides, TC/HDL-c ratio, non-HDL cholesterol) and glycidic profile (fasting glucose, serum insulin, glycated hemoglobin, HOMA-IR, glucose/insulin ratio) were obtained. Weight, height and waist circumferences (WC) were assessed; BMI and EWET were calculated. Analysis of Covariance Models (ANCOVA) was used to assess the objectives. RESULTS: mean age of participants was 58.75 ± 12.41 years and 55.6% (n = 25) were men. After adjustment for age, gender and BMI, EWET was significantly associated with lower HDL-c (p = 0.02), higher TC/HDL-c ratio (p = 0.003) and a trend toward fasting glucose (p = 0.11). CONCLUSION: EWET phenotype seems to be associated with a worse lipidic profile in patients with newly diagnosed HA.

Introducción: el fenotipo de la cintura hipertrigliceridémica (CHT) ha sido poco estudiado en pacientes con enfermedad cardiovascular establecida. Objetivos: evaluar la posible asociación entre el CHT, el perfil glicídico y los lípidos en pacientes con nuevo diagnóstico de infarto. Métodos: estudio transversal en 45 pacientes con infarto de miocardio. Se obtuvieron los lípidos (colesterol total, HDL-c, LDL-c, triglicéridos séricos, relación CT/ HDL-c, colesterol no-HDL) y el perfil glicídico (glucosa, insulina sérica, hemoglobina glucosilada, HOMA-IR, relación glucosa/insulina). Fueron evaluados peso, talla y circunferencia de la cintura (CC); se calcularon el IMC y el CHT. Se utilizó el análisis de los modelos de covarianza (ANCOVA) para evaluar los objetivos. Resultados: la media de edad de los participantes fue de 58,75 ± 12,41 años, y el 55,6% (n = 25) eran hombres. Tras ajustar por edad, sexo y el IMC, el CHT se asoció significativamente con una menor HDL-c (p = 0,02), mayor relación CT/HDL-c (p = 0,003) y una tendencia hacia la glucosa en ayunas (p = 0,11). Conclusión: el fenotipo CHT parece estar asociado con un peor perfil lipídico en pacientes con diagnóstico reciente de infarto.

Association between LAP Index (Lipid Accumulation Product) and metabolic profile in hospitalized patients.

INTRODUCTION: Lipid Accumulation Product (LAP) Index correlates to cardiovascular risk factors in general population but it has not been tested in hospitalized patients. OBJECTIVES: We aimed to evaluate associations between LAP Index and metabolic profile in a tertiary hospital. METHODS: Cross-sectional study with 90 inpatients. Lipid profile, fasting glucose, systolic and diastolic blood pressure measurements were obtained from electronic medical records. Weight, height and waist circumferences (WC) were assessed; Body Mass Index (BMI) and LAP Index were calculated. Data were expressed as mean ± standard deviation or percentage. Pearson's correlation and Multiple Linear Regression were used to assess the objectives. RESULTS: Mean age of participants was 55.03 ± 14.86 years and 47.8% (n = 43) were men. After adjustment for sex, age and physic activity LAP Index (log-transformed) was significantly associated with HDL-cholesterol (p < 0.001), fasting glucose (p = 0.02), systolic blood pressure (p = 0.03) and a trend toward total cholesterol (p = 0.07). CONCLUSION: There are independent association between LAP Index (log-transformed) and metabolic profile in hospitalized patients.

Introducción: el índice PAL (Producto de Acumulación Lipídica) se correlaciona con factores de riesgo cardiovasculares en la población general, pero no ha sido probado en pacientes hospitalizados. Objetivos: evaluar las asociaciones entre el índice PAL y el perfil metabólico en un hospital de tercer nivel. Métodos: estudio transversal con 90 pacientes hospitalizados. Se obtuvieron de los registros médicos electrónicos el perfil lipídico, la glucosa en ayunas y las mediciones de la presión arterial sistólica y diastólica. Fueron evaluados el peso, la talla y la circunferencia de la cintura (CC); se calcularon el Índice de Masa Corporal (IMC) y el Índice de PAL. Los datos se expresan como media ± desviación estándar o porcentaje. Para evaluar los objetivos se utilizaron la correlación de Pearson y la regresión lineal múltiple. Resultados: la edad promedio de los participantes fue de 55,03 ± 14,86 años y el 47,8% (n = 43) eran hombres. Después de ajustar por sexo, edad y actividad física, el índice PAL (transformado-log) se asoció significativamente con el HDL-colesterol (p < 0,001), la glucosa en ayunas (p=0,02), la presión arterial sistólica (p = 0,03) y una tendencia hacia el colesterol total (p = 0,07). Conclusión: en los pacientes hospitalizados existe una asociación independiente entre el índice PAL (transformado- log) y el perfil metabólico.

Association between LAP Index (lipid accumulation product) and metabolic profile in hospitalized patients / Asociación entre el índice de PAL (el Producto de Acumulación Lipídica) y el perfil metabólico en pacientes hospitalizados

Introduction: lipid Accumulation Product (LAP) Index correlates to cardiovascular risk factors in general population but it has not been tested in hospitalized patients. Objectives: we aimed to evaluate associations between LAP Index and metabolic profile in a tertiary hospital. Methods: Cross-sectional study with 90 inpatients. Lipid profile, fasting glucose, systolic and diastolic blood pressure measurements were obtained from electronic medical records. Weight, height and waist circumferences (WC) were assessed; Body Mass Index (BMI) and LAP Index were calculated. Data were expressed as mean ± standard deviation or percentage. Pearson’s correlation and Multiple Linear Regression were used to assess the objectives. Results: mean age of participants was 55.03 ± 14.86 years and 47.8% (n = 43) were men. After adjustment for sex, age and physic activity LAP Index (log-transformed) was significantly associated with HDL-cholesterol (p< 0.001), fasting glucose (p = 0.02), systolic blood pressure (p = 0.03) and a trend toward total cholesterol (p = 0.07). Conclusion: There are independent association between LAP Index (log-transformed) and metabolic profile in hospitalized patients (AU)

Introducción: el índice PAL (Producto de Acumulación Lipídica) se correlaciona con factores de riesgo cardiovasculares en la población general, pero no ha sido probado en pacientes hospitalizados. Objetivos: evaluar las asociaciones entre el índice PAL y el perfil metabólico en un hospital de tercer nivel. Métodos: estudio transversal con 90 pacientes hospitalizados. Se obtuvieron de los registros médicos electrónicos el perfil lipídico, la glucosa en ayunas y las mediciones de la presión arterial sistólica y diastólica. Fueron evaluados el peso, la talla y la circunferencia de la cintura (CC); se calcularon el Índice de Masa Corporal (IMC) y el Índice de PAL. Los datos se expresan como media ± desviación estándar o porcentaje. Para evaluar los objetivos se utilizaron la correlación de Pearson y la regresión lineal múltiple. Resultados: la edad promedio de los participantes fue de 55,03 ± 14,86 años y el 47,8% (n = 43) eran hombres. Después de ajustar por sexo, edad y actividad física, el índice PAL (transformado-log) se asoció significativamente con el HDL-colesterol (p < 0,001), la glucosa en ayunas (p=0,02), la presión arterial sistólica (p = 0,03) y una tendencia hacia el colesterol total (p = 0,07). Conclusión: en los pacientes hospitalizados existe una asociación independiente entre el índice PAL (transformado-log) y el perfil metabólico (AU)

Xanthine oxidase activity is associated with risk factors for cardiovascular disease and inflammatory and oxidative status markers in metabolic syndrome: effects of a single exercise session.

OBJECTIVE: The main goal of the present study was to investigate the xanthine oxidase (XO) activity in metabolic syndrome in subjects submitted to a single exercise session. We also investigated parameters of oxidative and inflammatory status. MATERIALS/METHODS: A case-control study (9 healthy and 8 MS volunteers) was performed to measure XO, superoxide dismutase (SOD), glutathione peroxidase activities, lipid peroxidation, high-sensitivity C-reactive protein (hsCRP) content, glucose levels, and lipid profile. Body mass indices, abdominal circumference, systolic and diastolic blood pressure, and TG levels were also determined. The exercise session consisted of 3 minutes of stretching, 3 minutes of warm-up, 30 minutes at a constant dynamic workload at a moderate intensity, and 3 minutes at a low speed. The blood samples were collected before and 15 minutes after the exercise session. RESULTS: Serum XO activity was higher in MS group compared to control group. SOD activity was lower in MS subjects. XO activity was correlated with SOD, abdominal circumference, body mass indices, and hsCRP. The single exercise session reduced the SOD activity in the control group. CONCLUSIONS: Our data support the association between oxidative stress and risk factors for cardiovascular diseases and suggest XO is present in the pathogenesis of metabolic syndrome.

Hábitos Alimentares, Atividade Física e Escore de Risco Global de Framingham na Síndrome Metabólica / Alimentary Habits, Physical Activity, and Framingham Global Risk Score in Metabolic Syndrome

Fundamento: A síndrome metabólica é um transtorno complexo representado por um conjunto de fatores de risco cardiovascular. A adoção de um estilo de vida saudável está fortemente relacionada à melhora da Qualidade de Vida e interfere de forma positiva no controle dos fatores de risco presentes nessa condição clínica. Objetivo: Avaliar o efeito de um programa de modificação do estilo de vida sobre o Escore de Risco Cardiovascular Global de Framingham em indivíduos com síndrome metabólica. Método: Trata-se de uma subanálise de um ensaio clínico randomizado, controlado, cegado, com duração de três meses. Os participantes foram randomizados em quatro grupos: intervenção nutricional + placebo (INP), intervenção nutricional + suplementação de ácidos graxos ômega 3 (3 g/dia de óleo de peixe) (INS3), intervenção nutricional + atividade física + placebo (INEP) e intervenção nutricional + atividade física + suplementação de ácidos graxos ômega 3 (INES3). O Escore de Risco Cardiovascular Global de Framingham de cada indivíduo foi calculado antes e após a intervenção. Resultados: Participaram do estudo 70 indivíduos. Observou-se uma redução da média do escore após a intervenção de forma geral (p < 0,001). Obteve-se uma redução para risco intermediário em 25,7% dos indivíduos. Após a intervenção, observou-se redução significativa (p < 0,01) da "idade vascular", sendo esta mais expressiva nos grupos INP (5,2%) e INEP (5,3%). Conclusão: Todas as intervenções propostas produziram efeito benéfico para a redução do escore de risco cardiovascular. O presente estudo reforça a importância da ...

Background: Metabolic syndrome is a complex disorder represented by a set of cardiovascular risk factors. A healthy lifestyle is strongly related to improve Quality of Life and interfere positively in the control of risk factors presented in this condition. Objective: To evaluate the effect of a program of lifestyle modification on the Framingham General Cardiovascular Risk Profile in subjects diagnosed with metabolic syndrome. Methods: A sub-analysis study of a randomized clinical trial controlled blind that lasted three months. Participants were randomized into four groups: dietary intervention + placebo (DIP), dietary intervention + supplementation of omega 3 (fish oil 3 g/day) (DIS3), dietary intervention + placebo + physical activity (DIPE) and dietary intervention + physical activity + supplementation of omega 3 (DIS3PE). The general cardiovascular risk profile of each individual was calculated before and after the intervention. Results: The study included 70 subjects. Evaluating the score between the pre and post intervention yielded a significant value (p < 0.001). We obtained a reduction for intermediate risk in 25.7% of subjects. After intervention, there was a significant reduction (p < 0.01) on cardiovascular age, this being more significant in groups DIP (5.2%) and DIPE (5.3%). Conclusion: Proposed interventions produced beneficial effects for reducing cardiovascular risk score. This study emphasizes the importance of lifestyle modification in the prevention and treatment of cardiovascular diseases. .

Alimentary habits, physical activity, and Framingham global risk score in metabolic syndrome.

BACKGROUND: Metabolic syndrome is a complex disorder represented by a set of cardiovascular risk factors. A healthy lifestyle is strongly related to improve Quality of Life and interfere positively in the control of risk factors presented in this condition. OBJECTIVE: To evaluate the effect of a program of lifestyle modification on the Framingham General Cardiovascular Risk Profile in subjects diagnosed with metabolic syndrome. METHODS: A sub-analysis study of a randomized clinical trial controlled blind that lasted three months. Participants were randomized into four groups: dietary intervention + placebo (DIP), dietary intervention + supplementation of omega 3 (fish oil 3 g/day) (DIS3), dietary intervention + placebo + physical activity (DIPE) and dietary intervention + physical activity + supplementation of omega 3 (DIS3PE). The general cardiovascular risk profile of each individual was calculated before and after the intervention. RESULTS: The study included 70 subjects. Evaluating the score between the pre and post intervention yielded a significant value (p < 0.001). We obtained a reduction for intermediate risk in 25.7% of subjects. After intervention, there was a significant reduction (p < 0.01) on cardiovascular age, this being more significant in groups DIP (5.2%) and DIPE (5.3%). CONCLUSION: Proposed interventions produced beneficial effects for reducing cardiovascular risk score. This study emphasizes the importance of lifestyle modification in the prevention and treatment of cardiovascular diseases.