Original paper

Is there a role for lifestyle changes in cardiovascular prevention? What, when and how?

  • Experts agree that lifestyle changes including a healthy diet are important for cardiovascular disease (CVD) prevention.
  • A healthy diet is recommended for everyone and should be adapted to local culture and environment.
  • Amongst functional foods and food supplements, plant sterols/stanols at doses of 2-3 g/day are recommended as they have a proven cholesterol-lowering effect. Clinical studies support their LDL-cholesterol-lowering effect, but there is yet no evidence on CVD event reduction.

The expert working group reviewed existing guidelines, clinical practice and research evidence to provide recommendations on ten proposed lifestyle changes and their impact on cardiovascular disease (CVD) risk prevention.

They agreed that:

  1. A Mediterranean diet high in fruits, vegetables, seeds, nuts, fish, whole cereals and extra-virgin olive oil is beneficial to all for CVD prevention. Tailoring diets to the needs of specific communities and patients is also important.
  2. Moderate alcohol consumption of mostly wine or beer is probably beneficial to heart health but may increase the risk of several cancers.
  3. Encourage people to eat a healthy food-based diet based on whole foods with the mantra ‘Unwrap less, peel more”.
  4. There is not enough evidence that a low-fat diet is beneficial for CVD prevention, but there is strong evidence for promoting a Mediterranean diet.
  5. Functional foods: Phytosterols at 1.6-3 g per day reduce LDL-C by 10% in those not on medications or on a stable statin dose. In diets designed to reduce LDL-C, phytosterol-enriched foods may be recommended. There is no evidence to support the use of omega-3 supplementation. Diets should be high in natural sources of dietary fibre.
  6. Exercise, e.g. at least 30 minutes five days a week should be recommended but CV fitness should be assessed and high-risk patients and those engaging in high-intensity sport should be screened before starting exercise.
  7. Smoking cessation is a major modifiable risk factor for CVD. Hence, clinicians need to ask the right questions and be available with the right advice to help patients stop smoking.
  8. Nutritionists form an important part of any CV risk multidisciplinary team. Food-related advice needs to form an important part of daily practice in primary care and especially cardiologists would benefit from basic knowledge about how to talk with patients about CVD risk and nutrition. Public and occupational education is also required.
  9. Tools such as questionnaires to assess lifestyle and plan lifestyle modifications and interventions are useful.
  10. Rehabilitation programmes and a multidisciplinary team approach are needed when encouraging lifestyle changes. Motivational interviewing and a psychological assessment are recommended. Positive messages instead of negative ones are vital.

Taken together, lifestyle modification plays a key role in the prevention of CVD and experts agree on the evidence-based changes that can save lives and ill health. This review provides guidance and useful advice for clinicians and healthcare professionals on the role of lifestyle changes in the prevention of CVD.