What lifestyle changes are recommended for primary prevention of coronary artery disease?

Lifestyle Changes for Primary Prevention of Coronary Artery Disease

The most important way to prevent coronary artery disease is to promote a healthy lifestyle throughout life, including a heart-healthy diet, regular physical activity, smoking cessation, and maintaining a healthy body weight. 1

Dietary Modifications

• Consume a varied diet that emphasizes vegetables, fruits, nuts, whole grains, lean vegetable or animal protein, and fish (especially oily fish at least twice weekly) 1
• Minimize intake of trans fats, red meat, processed red meats, refined carbohydrates, and sweetened beverages 1
• Replace saturated fats with unsaturated fats, particularly polyunsaturated fats from plant sources 2, 3
• Moderate alcohol consumption 1
• Consider incorporating dietary adjuncts such as viscous fiber, plant sterols/stanols which can help lower cholesterol levels 4

Physical Activity

• Engage in at least 150 minutes per week of moderate-intensity physical activity or 75 minutes per week of vigorous-intensity physical activity 1
• Incorporate regular aerobic exercise into your routine 1
• Physical activity helps improve lipid profiles, reduce blood pressure, and maintain healthy weight 4

Weight Management

• Aim for a healthy body weight with a body mass index (BMI) < 25 kg/m² 1
• Avoid central obesity (excess fat around the waistline) 1
• For individuals with overweight or obesity, counseling and caloric restriction are recommended for achieving and maintaining weight loss 1

Tobacco Use

• Complete cessation of smoking is essential 1
• Avoid exposure to environmental tobacco smoke (secondhand smoke) 1
• All adults should be assessed at every healthcare visit for tobacco use, and those who use tobacco should be assisted and strongly advised to quit 1

Blood Pressure Control

• Aim for blood pressure < 140 mm Hg systolic and < 85 mm Hg diastolic 1
• Lifestyle modifications for blood pressure control include reducing sodium intake, increasing consumption of fruits and vegetables, and maintaining physical activity 1

Cholesterol Management

• Target total cholesterol < 5.0 mmol/L (193 mg/dL) and LDL cholesterol < 3.0 mmol/L (116 mg/dL) 1
• Dietary strategies to improve cholesterol include limiting saturated fat and dietary cholesterol while increasing intake of foods rich in soluble fiber 1, 4

Diabetes Management

• For those with diabetes, lifestyle changes including dietary improvements and meeting exercise recommendations are crucial 1
• Aim for optimal glycemic control with HbA1c < 7% 1
• Diabetes-specific targets include stricter blood pressure control (< 130/80 mmHg) 1

Common Pitfalls to Avoid

• Simply lowering total fat intake without attention to fat quality may not improve cardiovascular outcomes 2, 5
• Replacing saturated fats with refined carbohydrates or added sugars may actually increase cardiovascular risk 5, 3
• Focusing on single nutrients rather than overall dietary pattern may lead to suboptimal results 4
• Neglecting the importance of regular physical activity alongside dietary changes 1

Risk Assessment

• Adults aged 40-75 years should undergo 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimation 1
• Those at higher risk (>15% 10-year risk) may need more intensive lifestyle interventions and possibly medication 1
• Screening of first-degree blood relatives of patients with premature coronary heart disease is recommended 1

By implementing these comprehensive lifestyle changes, individuals can significantly reduce their risk of developing coronary artery disease. The evidence strongly supports that these modifications can have a substantial impact on cardiovascular health and mortality.