What lifestyle modifications are recommended for a patient with a 1% Atherosclerotic Cardiovascular Disease (ASCVD) risk score?

From the Guidelines

Even with a low ASCVD risk score of 1%, making lifestyle modifications is crucial for maintaining cardiovascular health and reducing morbidity, mortality, and improving quality of life. The most recent and highest quality study, 1, emphasizes the importance of promoting a healthy lifestyle throughout life to prevent ASCVD.

Key Lifestyle Modifications

• Focus on regular physical activity, aiming for at least 150 minutes of moderate-intensity exercise weekly, such as brisk walking, swimming, or cycling.
• Adopt a heart-healthy diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats like those found in olive oil, nuts, and fatty fish.
• Limit sodium intake to less than 2,300 mg daily and minimize processed foods, saturated fats, and added sugars.
• If you smoke, quitting is essential as it significantly reduces cardiovascular risk.
• Maintain a healthy weight through balanced nutrition and regular exercise, and limit alcohol consumption to moderate levels (up to one drink daily for women and two for men).
• Manage stress through techniques like meditation, yoga, or deep breathing exercises.

As stated in 1, prevention strategies must include a strong focus on lifestyle optimization to minimize the risk of future ASCVD events. A comprehensive patient-centered approach that addresses all aspects of a patient’s lifestyle habits and estimated risk of a future ASCVD event is the first step in deciding on where there may be a need for pharmacotherapy.

Additional Considerations

• According to 1, lifestyle modification remains a crucial component of health promotion, and should be emphasized on a regular basis.
• The 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease, 1, highlights the importance of moving individuals toward ideal cardiovascular health to prevent many important health conditions.
• By making these lifestyle changes, individuals can not only maintain their currently low risk status but also experience numerous other health benefits, including improved energy levels, better sleep quality, and reduced risk of other chronic diseases.

From the FDA Drug Label

Lipid-altering agents should be used in addition to a diet restricted in saturated fat and cholesterol when response to diet and non-pharmacological interventions alone has been inadequate Excess body weight and excess alcoholic intake may be important factors in hypertriglyceridemia and should be addressed prior to any drug therapy Physical exercise can be an important ancillary measure. The initial treatment for dyslipidemia is dietary therapy specific for the type of lipoprotein abnormality. The use of drugs should be considered only when reasonable attempts have been made to obtain satisfactory results with non-drug methods 0 to 1 Risk Factor‡ < 160 ≥ 160 ≥ 190 (160-189: LDL-lowering drug optional)

For an ASCVD risk score of 1%, the following lifestyle modifications can be made:

• Dietary therapy: restricted in saturated fat and cholesterol
• Weight management: addressing excess body weight
• Alcohol reduction: reducing or eliminating excess alcoholic intake
• Physical exercise: as an important ancillary measure The goal is to achieve an LDL-C level of less than 160 mg/dL, and if the TG is still ≥ 200 mg/dL, non-HDL-C becomes a secondary target of therapy 2

From the Research

Lifestyle Modifications for ASCVD Risk Score of 1%

For individuals with an ASCVD risk score of 1%, the following lifestyle modifications can be considered:

• Adhering to a Mediterranean-type diet 3
• Patient-centered counseling 3
• Standardized risk assessment for patients over the age of 40 3
• Avoiding routine prescriptions of nicotinic acid, aspirin, and fibrates for primary ASCVD prevention alone 3
• Recommending 20 mg/day of atorvastatin for high-risk ASCVD patients, although this may not be directly applicable to those with a 1% risk score 3

Additional Considerations

Additional considerations for lifestyle modifications include:

• Assessing baseline ASCVD risk using global risk scores based on standard office-based measures 4
• Using "risk enhancing" factors, including traditional risk factors and novel biomarkers and inflammatory factors, to further assess ASCVD risk 4
• Screening for subclinical atherosclerosis, especially with the use of coronary calcium screening, to further inform treatment decisions 4
• Focusing on lifestyle management and the risks and benefits of evidence-based pharmacologic therapies to best lower ASCVD risk 4

Limitations

It is essential to note that the provided evidence primarily focuses on high-risk ASCVD patients, and more research is needed to determine the most effective lifestyle modifications for individuals with a 1% ASCVD risk score 5, 6, 7, 3, 4