Digital lifestyle interventions for cardiovascular risk reduction: A systematic review and network meta-analysis

Objectives

To compare the relative effectiveness of different digital lifestyle interventions in improving cardiovascular risk factors.

Methods

A comprehensive systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs) was conducted. Seven electronic databases were searched from 1990 to April 4, 2024. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. A Bayesian random-effects network meta-analysis (NMA) was performed. Continuous outcomes are reported as mean differences (MD) with their 95 % credible intervals (CrI).

Results

The combinations of physical activity + diet + smoking cessation (PA+D+Sm), and physical activity + diet (PA+D) components were the most effective interventions, leading to substantial improvements in multiple cardiovascular risk factors compared to usual care or some other digital lifestyle interventions with low to high certainty. Dietary interventions significantly reduced body weight and glycosylated hemoglobin (HbA1c) compared to usual care. Although the effect sizes did not meet established clinical significance thresholds for most cardiovascular risk factors, they still hold clinical relevance, highlighting the potential for significant health improvements.

Conclusions

Multifactorial digital lifestyle interventions, particularly those combining PA+D+Sm and PA+D components, appear the most promising for reducing cardiovascular risk factors.