Diet and Physical Activity for Cardiovascular Disease Prevention

 


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Am Fam Physician. 2016 Jun 1;93(11):919-924.

  Patient information: A handout on this topic is available at http://familydoctor.org/familydoctor/en/diseases-conditions/coronary-artery-disease/prevention/diet-and-exercise-for-a-healthy-heart.html.

Author disclosure: No relevant financial affiliations.

Cardiovascular disease (CVD) is the leading cause of death in the United States. One-third of these deaths may be preventable through healthy lifestyle choices including diet and physical activity. The Mediterranean diet is associated with reduced cardiovascular mortality, whereas the Dietary Approaches to Stop Hypertension (DASH) eating plan is associated with a reduced risk of coronary artery disease. Substituting dietary saturated fat with polyunsaturated fatty acids is associated with improved cardiovascular outcomes, although exogenous supplementation with omega-3 fatty acids does not improve cardiovascular outcomes. There is an association between increased sodium intake and cardiovascular risk, but reducing dietary sodium has not consistently shown a reduction in cardiovascular risk. Physical activity recommendations for adults are at least 150 minutes of moderate-intensity aerobic activity per week, 75 minutes of vigorous-intensity aerobic activity per week, or an equivalent combination. Increases in physical activity by any level are associated with reduced cardiovascular risk. Introducing muscle-strengthening activities at least twice per week in previously inactive adults is associated with improved cardiovascular outcomes. Inactive adults without known CVD can gradually increase activity to a moderate-intensity level without consulting a physician. The U.S. Preventive Services Task Force recommends behavioral counseling to promote healthy diet and physical activity in adults at high risk of CVD. Evidence of benefit for counseling patients at average risk is less established.

Cardiovascular disease (CVD) is the leading cause of death in the United States.1 From 2008 to 2010, CVD accounted for 272,668 deaths annually in persons younger than 80 years. Nearly one-third of deaths from CVD are considered potentially preventable.1 The American Heart Association (AHA) has published recommendations defining ideal cardiovascular health. Recommendations for physical activity in adults are at least 150 minutes of moderate-intensity aerobic activity or at least 75 minutes of vigorous-intensity aerobic activity per week.2  Ideal cardiovascular health also includes adhering to at least four of five components of a diet consistent with the Dietary Approaches to Stop Hypertension (DASH) eating plan (Table 1).2

WHAT IS NEW ON THIS TOPIC: CARDIOVASCULAR DISEASE PREVENTION

Benefits of combined lifestyle interventions to reduce cardiovascular disease risk may be more pronounced in groups at higher risk, such as patients with diabetes mellitus or hypertension.

Any physical activity is associated with lower cardiovascular risk, and the benefit increases with increasing amounts of weekly physical activity.

Although increased sodium intake has been associated with stroke and cardiovascular disease, a 2014 Cochrane review evaluating dietary sodium restriction in normotensive and hypertensive patients showed no effect on cardiovascular outcomes or all-cause mortality.

View/Print Table

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Adults should follow an eating plan consistent with the Dietary Approaches to Stop Hypertension diet or the Mediterranean diet.

A

11, 13, 14

Substituting dietary saturated fat with polyunsaturated fat is recommended to reduce cardiovascular risk.

B

18

Adults healthy enough to exercise should engage in at least 150 minutes of moderate-intensity aerobic activity, 75 minutes of vigorous-intensity aerobic activity, or an equivalent combination, each week.

A

27, 28

Physically inactive adults should be counseled that any increase in physical activity is associated with a reduction in cardiovascular risk.

A

27, 28

Muscle-strengthening activity at least twice per week in previously inactive adults is associated with improved cardiovascular outcomes.

B

29

Adults without a significant history of cardiovascular disease can gradually increase their activity level to moderate intensity safely without consulting a physician.

C

27


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Adults should follow an eating plan consistent with the Dietary Approaches to Stop Hypertension diet or the Mediterranean diet.

A

11, 13, 14

Substituting dietary saturated fat with polyunsaturated fat is recommended to reduce cardiovascular risk.

B

18

Adults healthy enough to exercise should engage in at least 150 minutes of moderate-intensity aerobic activity, 75 minutes of vigorous-intensity aerobic activity, or an equivalent combination, each week.

A

27, 28

Physically inactive adults should be counseled that any increase in physical activity is associated with a reduction in cardiovascular risk.

A

27, 28

The Authors

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JEFFREY B. LANIER, MD, FAAFP, is a physician recruiter for the United States Army Recruiting Command and a staff family physician at Ireland Army Community Hospital, Fort Knox, Ky. At the time the article was written, he was the associate residency director at Martin Army Community Hospital Family Medicine Residency Program, Fort Benning, Ga....

DAVID C. BURY, DO, is a staff family physician at U.S. Army Health Clinic, Camp Casey, South Korea. At the time the article was written, he was a third-year family medicine resident at Martin Army Community Hospital Family Medicine Residency Program.

SEAN W. RICHARDSON, DO, is a third-year family medicine resident at Martin Army Community Hospital Family Medicine Residency Program.

Author disclosure: No relevant financial affiliations.

Address correspondence to Jeffrey B. Lanier, MD, U.S. Army Medical Recruiting Brigade, 1889 Old Ironsides Ave., Ft. Knox, KY 40121 (e-mail: jeffrey.b.lanier.mil@mail.mil). Reprints are not available from the authors.

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