title: Advancing cardiovascular disease prevention in asymptomatic carotid artery disease: integrative approaches through dietary interventions, multidisciplinary programs, and adherence strategies
Creators: name: Bensaaud, Abdelsalam
Publisher: name: University of Galway
Year: 2025
Subjects: subject: Cardiovascular disease
subject: DASH diet
subject: multidisciplinary prevention
subject: adherence strategies
subject: asymptomatic carotid artery disease
subject: randomized controlled trial
subject: public health
subject: clinical guidelines
subject: Medicine

description: Background Cardiovascular disease (CVD) is the leading global cause of mortality, responsible for 17.9 million deaths annually, with significant economic burdens. Modifiable risk factors, such as poor diet, physical inactivity, and low adherence to preventive strategies, contribute to its high prevalence. High-risk populations, such as those with asymptomatic carotid artery disease (ACAD), face limited effectiveness in current prevention approaches due to insufficient integration of multidisciplinary care and adherence strategies. Objectives This thesis aimed to advance CVD prevention by: 1. Systematically evaluating the DASH diet’s impact on cardiovascular events and risk factors. 2. Investigating outcomes of a novel multidisciplinary risk management program (IP-CARD) for ACAD patients. 3. Assessing the effectiveness of telephone reminders in improving adherence in cardiovascular clinical trials. Methods Three interconnected studies were conducted: 1. A Cochrane systematic review of randomized controlled trials (RCTs) assessed the DASH diet’s effects on cardiovascular outcomes and risk factors. 2. A single-center RCT evaluated the IP-CARD program’s impact on non-fatal cardiovascular events, carotid stenosis progression, and quality of life in ACAD patients. 3. A Study Within a Trial (SWAT) explored the role of telephone reminders in enhancing adherence during a cardiovascular prevention trial. Results 1. DASH Diet Review: The systematic review included five RCTs and demonstrated significant reductions in blood pressure and cholesterol profiles. However, evidence on its effects on myocardial infarction, stroke, or mortality was inconclusive due to limited sample sizes and follow-up durations. 2. IP-CARD Program: The RCT showed a significant reduction in non-fatal cardiovascular events and carotid stenosis progression. Intervention participants achieved better control of blood pressure, LDL cholesterol, and physical activity, alongside significant quality-of-life improvements. 3. SWAT on Adherence: Telephone reminders significantly improved adherence rates and engagement with trial protocols, with potential reductions in dropout rates and improved adherence scores. Conclusions This thesis highlights the potential of integrative approaches combining dietary interventions, multidisciplinary programs, and adherence strategies to reduce CVD risk in high-risk populations. While the DASH diet effectively reduces cardiovascular risk factors, further large-scale, long-term trials are needed to confirm its impact on major events like myocardial infarction and stroke. The IP-CARD program demonstrates the value of structured multidisciplinary interventions in managing ACAD, while adherence strategies, such as telephone reminders, optimize trial engagement and outcomes. Implications This research offers actionable insights for clinical practice, public health policy, and future research. It supports the integration of evidence-based dietary, lifestyle, and adherence interventions into clinical guidelines. Structured prevention programs for ACAD patients and high-risk populations, combined with robust adherence strategies, can significantly reduce the global burden of CVD while improving patient quality of life. These findings emphasize the need for funding and policy support to implement and sustain these programs on a broader scale.