Background and study objectives: Cardiovascular
diseases and diabetes mellitus are
highly prevalent disorders to which lifestyle
factors make a marked contribution. This study
aimed to investigate whether specific advice
on lifestyle changes with determination of
the risk of developing a heart attack or diabetes
could achieve a reduction in this risk (primary
prevention). The intima-media thickness
(IMT) of the a. carotis communis (ACC)
is a surrogate parameter for systemic atherosclerosis.
It was also investigated whether
the intima-media thickness and plaque formation
correlated with the level of classical
risk factors expressed in PROCAM risk scores.
Methods: The determination of the risk of
developing a heart attack or diabetes was offered
to persons undergoing medical checkups
at work. Persons who had already had a
heart attack or who were undergoing treatment
were excluded. For 221 men the risk
of developing a heart attack or diabetes was
determined with the PROCAM risk score 2004
and the German Diabetes Risk Score and for
213 men the intima-media thickness of the
a. carotis communis bilaterally and manually.
A thickening ≥ the 75th percentile was
considered to be abnormal. The assessment
of plaques was based on the Mannheim consensus
papers 2004–2006. The risk of developing
a heart attack was calculated for age
65, to make the large increase in risk with
age apparent. For all persons the maximum
achievable reduction in risk was calculated,
to make it clear to what extent the risks can
be altered. Then the persons were advised as
to changes in the lifestyle factors smoking,
diet, sport and body weight. After changes in
their lifestyle every person could have a new
risk determination carried out.
Results: Of the 80 persons who had a followup
risk determination carried out, 43 had
been able by changing their lifestyle (6 with
additional statin therapy) to reduce their risk
of having a heart attack by a median of 1.8 %
(average 4.4 %) and their risk of developing
diabetes by a median of 0.46 % (average
1.6 %). The risk of developing plaques or intima
thickening correlated well with the level
of classical risk factors expressed as PROCAM
scores. Per PROCAM score point the risk of
an increased plaque rate increases by about
1.095 and for an intima thickening ≥ the 75th
percentile by about 1.103 Persons with up
to 25 PROCAM score points had no plaques
on the carotid artery, in 90 % of those with
56 points and more plaques were detected.
The risk of an increased plaque rate for persons
who exercised at least 3 times weekly
was as little as 0.139 (odds ratio) times that
of those who exercised less often (95% confidence
interval [0.03; 0.623], p-value 0.01).
The risk of intima thickening for persons who
exercised at least 3 times weekly was 0.338
(odds ratio) times that of those who exercised
less often (95% confidence interval
[0.116; 0.984], p-value 0.047). In 31 % of persons
with a risk of developing a heart attack
< 10 % according to PROCAM 2004, subclinical
atherosclerosis can already be demonstrated.
Conclusions: Determination of the risk of
developing a heart attack or diabetes with
the PROCAM risk score 2004 and the German
diabetes risk score and determination of the
intima-media thickness of the A. carotis communis
are useful instruments in preventive
medicine. After being advised specifically
about changes in lifestyle, persons were
able to reduce their personal risks markedly.
Regular endurance training seems to reduce
markedly the risk of developing plaques and
intima thickening.
