Cardiovascular Disease Management
Diet and lifestyle modifications remain the foundation of cardiovascular disease prevention and management, offering the greatest potential for risk reduction even in the era of advanced pharmacological therapies. 1
Core Management Goals
The American Heart Association establishes seven fundamental targets for CVD risk reduction 1:
- Consume an overall healthy diet emphasizing whole foods over individual nutrients 1
- Achieve and maintain healthy body weight (BMI 18.5-24.9 kg/m²) 1
- Optimize lipid profile targeting LDL, HDL, and triglyceride levels 1
- Control blood pressure to normal ranges 1
- Maintain normal blood glucose levels 1
- Engage in regular physical activity 1
- Eliminate tobacco use and exposure 1
Dietary Recommendations
Whole Diet Approach
Rather than focusing on isolated nutrients, implement a comprehensive dietary pattern 1:
- Increase consumption of fruits, vegetables, whole grains, legumes, and fiber-rich foods 1
- Choose lean proteins including fish (especially oily fish at least twice weekly), poultry, and plant-based sources 1
- Select low-fat dairy products over full-fat versions 1
- Limit total fat to <30% of energy intake, with saturated fat comprising less than one-third of total fat 1
- Restrict dietary cholesterol to <300 mg/day 1
- Replace saturated fats with monounsaturated and polyunsaturated fats from vegetable and marine sources 1
- Reduce sodium intake by avoiding table salt and selecting low-sodium processed foods 1
- Minimize refined carbohydrates, added sugars, and sugar-sweetened beverages 1
- Limit red and processed meats 1
Energy Balance
Balance caloric intake with physical activity to achieve or maintain healthy body weight 1. Obesity independently increases CVD risk by adversely affecting lipid profiles, blood pressure, and glucose metabolism 1.
Physical Activity Requirements
Perform at least 150-300 minutes of moderate-intensity aerobic activity weekly, or 75-150 minutes of vigorous-intensity activity, plus strength training at least twice weekly 1. For patients with established CVD, exercise prescriptions should be based on comprehensive clinical assessment including exercise testing 1.
Physical activity interventions should 1:
- Emphasize gradually increasing aerobic activities, particularly walking 1
- Target 60-75% of maximum heart rate for moderate intensity 1
- Be enjoyable and fit into daily routines to improve adherence 1
- Include supervised cardiac rehabilitation programs for patients with known CVD 1
Weight Management
Target BMI 18.5-24.9 kg/m² and waist circumference <102 cm in men, <88 cm in women 1. Weight reduction is strongly indicated for those with BMI ≥25 kg/m² or increased abdominal fat, as visceral adiposity is a metabolically active risk factor 1.
Blood Pressure Control
Initiate antihypertensive therapy for sustained BP ≥140/90 mmHg in high-risk individuals or those with target organ damage 1. For patients with established CVD, blood pressure targets should be individualized based on underlying cardiovascular conditions 1.
Lipid Management
Saturated and trans-fatty acids are the strongest dietary determinants of elevated LDL cholesterol 1. For primary prevention in patients with significant obstructive CAD, aspirin 75-100 mg daily is recommended lifelong 1.
In the ASCOT trial, atorvastatin 10 mg daily reduced coronary events by 36% (p=0.0005) in hypertensive patients with multiple risk factors but no prior MI 2. For patients with type 2 diabetes and additional risk factors, atorvastatin 10 mg daily reduced major cardiovascular events by 37% (p=0.001) in the CARDS trial 2.
Tobacco Cessation
Complete avoidance of tobacco products and secondhand smoke exposure is mandatory 1. This represents one of the most modifiable and impactful risk factors for CVD prevention 1.
Clinical Implementation
Diet and lifestyle therapies are commonly neglected in clinical practice despite being the foundation of CVD prevention 1. For patients at higher risk, recommendations should be intensified beyond general population guidelines 1.
Multidisciplinary behavioral approaches combining professional dietary counseling, exercise programs, and behavioral support are more effective than isolated interventions 1. However, even low-intensity interventions using print or web-based materials with tailored feedback can provide measurable benefits 1.
Special Considerations
For patients with inflammatory joint disorders (RA, AS, PsA), corticosteroid dosage should be minimized and tapered when possible, as doses ≥8-15 mg/day are associated with dose-dependent CVD risk increases 1. Mediterranean dietary patterns may provide additional benefits in these populations through effects on disease activity 1.