Cardiovascular diseases (CVD) are the leading cause of death worldwide,^1-4 and actions to address this problem have been developed with positive results, especially in more developed regions.^1-6

The recommended actions are aimed at reducing behavioral risk factors and controlling chronic diseases, such as hypertension, diabetes, and obesity.^2,5 Because companies employ workers in the age group most prone to CVD, they play an important role in the early identification and control of these disease factors, as they have favorable conditions to plan, implement, monitor, control, and evaluate the effectiveness of the actions developed.^7-12

Thus, companies that invest in health promotion have implemented programs aimed at reducing CVD risk factors.^7-11 However, results on the effectiveness of these actions are scarce in the literature, especially when looking for studies that compared different methodologies.^12-15 This study compared the effect of implementing two CVD prevention programs in an oil company, with the aim of verifying whether model A, which is more robust, would have better results than model B in reducing cardiovascular risk (CVR) among monitored workers.

In 2016, neither group presented differences in terms of age, marital status, and average time at the company; however, they did differ in terms of sex, education, income, and work regime (Table 1).

Regarding lifestyle habits, initially, the groups did not differ in smoking and consumption of sugary drinks; however, group B consumed more alcoholic beverages (p=0.03) and practiced less physical activity (p=0.01), but had a higher consumption of FVL (p<0.01).

The groups showed similar behavior for the variables of TC, and male and female HDL-C; however, they presented differences for the other variables related to the health profile of the workers. Despite this finding, the CVR, in 2016, showed no difference between the groups (p = 0.4). After two years, when comparing variables related to CVD risk factors between the groups, a difference was identified for male HDL-C, with a more pronounced reduction in group A (-5.8 ± 8.6 mg/dL; p < 0.01) than in group B (-0.3 ± 6.0 mg/dL; p < 0.01), and for triglycerides, which decreased in group A (- 9.6 ± 123.2 mg/dL; p = 0.01) and increased in group B (10.2 ± 66.4 mg/dL; p = 0.01). The behavior of CVR variation was similar between the groups (0.3 ± 2.4 vs 0.2 ± 2.1; p = 0.1). No difference was found for the other analyzed variables.

The groups were compared internally (Wilcoxon test) after two years of follow-up, and it was observed that, for behavioral variables, group A improved its PAL and consumption of FVL and alcohol, but it worsened its consumption of sugary drinks (p = 0.01), a fact also found in group B (p = 0.002).

As for risk factors for CVD, in the intragroup comparison, group A increased blood glucose, LDL-C, and female abdominal circumference; reduced male HDL-C and female HDL-C; and worsened its CVR. By contrast, group B showed an increase in blood glucose, BP, and CVR, with no changes in the other variables (Table 2).

The Central Illustration shows the CVR by category before and after intervention for the two groups. The CVR, compared by categories between groups at the two study moments, found a difference between the results obtained by the models (p < 0.01), with a higher risk of death in 10 years due to CVE for members of group A. The intragroup comparison by CVR categories also showed a difference, with group A increasing both the "intermediate" and "high" risk, while group B showed an increase only in "intermediate" risk (Graph 1).

The association of CVR categories and behavioral variables in 2018 was evaluated, and no difference was found for physically active individuals in the two groups. However, for alcohol abuse and adequate consumption of FV, a difference was found in group A, with "high" CVR being more frequent among those who drink more and for those who consume less FV. Regarding smoking, non-smokers had a higher frequency of "low" CVR than did smokers, both in group A and group B (Table 3).

This study verified the results of two different programs implemented in an oil company to prevent and control CVD. Model A was more robust, considering the professionals involved and the proposed actions, and it was therefore expected to obtain better results, both in the reduction of the prevalence of risk factors and in the reduction of CVD. Thus, after two years of intervention, it was observed that model A obtained better results for some behavioral variables, such as increasing the PAL and the consumption of FVL, and decreasing alcohol consumption, while model B did not change the profile identified in 2016. The justification for these results should not be related only to the guidelines provided regarding lifestyle habits, but above all to the environmental interventions carried out in the operational area, such as the provision of healthy food by the company and spaces built for the practice of physical activity during the workday. The verification of the association between the classification of CVR and behavioral variables found positive results for group A for "alcohol abuse" and "adequate consumption of FVL", reinforcing the thesis that actions aimed at adopting healthy habits contribute to reducing the risk of death from CVD.^16-19 However, for physical activity, this association was not found, since there was no difference in CVR between physically active and inactive individuals, contradicting the results of studies that demonstrated the beneficial relationship between physical activity and the reduction of risk factors for CVD.^20,21

Moreover, regarding behavioral habits, it was observed that non-smokers presented a "low" risk for CVE in both groups, confirming data from the literature on the subject, which indicate that this risk factor is an important cause of disability and death, not only for CVD, but also for other NCDs.^2,16,22

Despite the actions implemented by both programs and the results obtained by model A, no reduction in CVR was observed for workers in either group. Important risk factors, such as BP, overweight, hyperglycemia, and hypercholesterolemia, were not well controlled, which may explain the increase in CVR, especially for group A.

Other studies have discussed the effectiveness of CVD prevention and control programs in the workplace and have indicated, in most cases, the occurrence of behavioral changes, but with little impact on the reduction of CVR,^9-11,23,24 which is in line with what was observed here. The authors presented the following justifications: cultural issues related to workers,⁹ the short duration of the intervention, and the strategy adopted.^23,24 However, both these authors and others recognize that the corporate space is important for reducing CVD risk factors and indicates positive results,²⁵ such as those obtained by Unilever's Lamplighter program and the IC Health program in India.²⁶

The two programs evaluated in the present study differed in terms of methodology, with model B monitoring only those enrolled in the physical activity program during the period, while model A expanded its strategy, with environmental interventions and systematic monitoring of individuals with metabolic syndrome. The difference in methodology may be associated with the sociodemographic and occupational characteristics observed between the groups; however, the strategy used was not sufficient to achieve a reduction in CVR and adequate control of chronic diseases, regardless of the allocation group.

To justify this result, some hypotheses were raised, which should be verified in future studies, such as failure to monitor healthy individuals, immediate management support, worker adherence to the program, and the type of individual and group approach used. Thus, low investment in healthy individuals may have increased the risk of them acquiring risk factors for CVD, just as the failure of managers to release workers may have reduced participation in activities implemented by model A, since the focus on operational results may be above the health of workers. The establishment of clear goals and objectives, as well as the establishment of incentives for results achieved and effective communication with participants throughout the process, are factors indicated for the success of programs developed in companies.²⁶

Another point to be investigated would be the influence of the work regime on the CVR, since a significant percentage of workers in group A work in shifts, with more time away from the corporate space due to compensatory time off, and may adopt behaviors different from those recommended regarding food consumption and physical activity. It is a fact that the aging process increases the prevalence of CVD, and that reducing the risk of death caused by CVD is associated with reducing and controlling the risk factors for these diseases.²⁷ Coping strategies point to investing in healthy habits and early diagnosis and treatment.^1,2,16-22 It is also well-known that controlling these behavioral factors requires raising awareness and convincing the individual to change habits and adhere to treatments when necessary. It is essential to maintain a strict monitoring of individuals with chronic diseases, such as hypertension and diabetes, as well as to adopt strategies that ensure the individual's interest in remaining in the program and adhering to the recommendations.²⁸ In this sense, some studies that evaluated intervention programs that used strict participant monitoring procedures showed better results when compared to routine interventions.^15,29

This study did not aim to identify the strengths and weaknesses of the programs, and therefore does not have definitive answers for the failure to reduce CVD. However, it is important to emphasize that the strategies implemented should be reviewed. The creation of spaces for physical activity during working hours and the provision of adequate food within the school walls, in isolation, showed favorable results and should be expanded to all workers. Health promotion and NCD prevention measures should involve families and even the community where workers are inserted as a measure to increase adherence to program recommendations and ensure the reduction of risk factors and control of CVD.

The actions developed by the company had a positive impact on the lifestyle of workers monitored by program model A, but they were not sufficient to reduce CVR in any of the monitored groups.