Clinical Practice Guideline(s)

Cardiovascular Risk

Lifestyle Management to Reduce Cardiovascular Risk

(Affirmation of Value, April 2018)

The guideline on Lifestyle Management to Reduce Cardiovascular Risk was developed by the American College of Cardiology and the American Heart Association, and was endorsed with qualifications by the American Academy of Family Physicians.

Key Recommendations

  • Adults who would benefit from lowering of LDL-C and/or lowering of blood pressure should consume a dietary pattern that emphasizes intake of vegetables, fruits, and whole grains; includes low-fat dairy products, poultry, fish, legumes, non-tropical vegetable oils and nuts; and limits intake of sweets, sugar-sweetened beverages and red meats.
  • Adults who would benefit from lowering of LDL-C should reduce the percent of calories in their diet that come from saturated and trans fat, and should aim for a dietary pattern that achieves 5-6% of calories from saturated fat.
  • Adults who would benefit from lowering of their blood pressure should lower their sodium intake, consuming no more than 2,400 mg of sodium per day. Further reduction of sodium to 1,500 mg/day is associated with an even greater reduction in blood pressure. Reducing intake of sodium by at least 1,000 mg/day will decrease blood pressure, even if the desired daily sodium intake is not achieved
  • Adults should engage in aerobic physical activity to reduce LDL-C and non-HDL-C and to lower blood pressure. This should include 3-4 sessions per week lasting an average of 40 minutes per session and involving moderate-to-vigorous intensity physical activity.


  • The extrapolation of diet and activity consensus recommendations to the whole population when evidence only supports these recommendations for those with high blood pressure and hyperlipidemia.
  • The recommendation for individual salt restriction below 2.3 grams is based on low-level evidence.

See the full recommendation for details about dietary patterns and evidence summaries.

These guidelines are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute the individual judgment brought to each clinical situation by the patient’s family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These guidelines are only one element in the complex process of improving the health of America. To be effective, the guidelines must be implemented.