I. Encourage Healthy Lifestyle

objective

Promote lifestyle changes that will decrease the risk of CVD.

background

A healthy lifestyle is the foundation of primary prevention of CVD.  A healthy lifestyle also decreases the risk of developing other co-morbid conditions that increase the risk of CVD such as diabetes, elevated blood pressure, and depression.

recommendations

1. All  adults should be encouraged to adopt healthy lifestyles that may reduce the risk of cardiovascular disease, to include:
1. Tobacco cessation interventions offered to all smokers  [A]
2. Eat a healthy diet  [B]
3. Engage in 30 minutes or more of moderate intensity physical activity on most days of the week.  [B]

discussion

Smoking, diet, and exercise, habits are prominent modifiable risk factors to be considered in prevention efforts.  Clinical trials, as well as epidemiologic studies, support the association of a high-fat/cholesterol diet, sedentary lifestyle, and obesity with increased risk of CVD.  All patients should be advised on lifestyle changes as a matter of general health (NCEP ATP-III, 2002), and appropriate referral for counseling may be advisable.  There is evidence that CVD risk can be reduced with lifestyle modifications.

Smoking Cessation

Smoking cessation is one of the most effective ways to reduce risk for CVD and other atherosclerotic diseases.  Research demonstrates that the physician's advice to stop smoking increases quit rates compared with the absence of such advice (USDHHS, 2004).  Furthermore, there is substantial evidence that even brief smoking cessation treatments can be effective.  All physicians should strongly advise every patient who smokes to stop smoking, as their advice is often a key factor in patient’s decision to stop.

The USPSTF Update to the Preventive Services guideline 2003 stated:

• The USPSTF strongly recommends that clinicians screen all adults for tobacco use and provide tobacco cessation interventions for those who use tobacco products
• Brief tobacco cessation counseling interventions, including screening, brief counseling (3 minutes or less), and/or pharmacotherapy, have proven to increase tobacco abstinence rates, although there is a dose-response relationship between quit rates and the intensity of counseling.  Effective interventions may be delivered by a variety of primary care clinicians.

For detailed analyses of the evidence and recommendations, see the VA/DoD Clinical Practice Guideline for Tobacco Use – Update 2003

Physical Activity

A sedentary lifestyle is associated with a twofold increase in CVD risk (Blair, 1994).  Clinicians should advise patients of all ages to follow a well-balanced exercise plan consisting of stretching, aerobic activity, and strengthening (Mazzeo et al., 1998).  Although the exact exercise parameters for optimal CVD prevention have been difficult to determine, research clearly demonstrates a dose-response relationship to risk reduction with increasing activity and caloric expenditure (Pate et al., 1995; Joint British recommendations, 1998).  Therefore, current exercise guidelines for the general population are that every adult in the United States accumulate 30 minutes or more of moderate intensity aerobic physical activity on most (and preferably all) days of the week (Pate et al., 1995; ACSM, 1995; Pollock & Wilmore, 1990; Spate-Douglas et al., 1999). Patients who need specialized exercise programs may be referred to an exercise professional.

Healthy Diet

Healthy eating habits contribute to lowering risk factors for CVD.  Therefore, patients should be encouraged to maintain healthy eating habits that include intake of a variety of fruits, vegetables, whole grains, low-fat or nonfat dairy products, fish, legumes, and sources of protein low in saturated fat (e.g., poultry, lean meats, plant sources).  Patients should limit saturated fat intake to <10 percent of calories, limit cholesterol intake to <300 mg/dL, and limit intake of trans fatty acids (NCEP ATP-III, 2002).

Maintaining a healthy weight also contributes significantly to lowering CVD risk.  Clinicians should encourage maintenance of a healthy weight through an appropriate balance of physical activity, caloric intake, and formal behavioral programs when indicated, to maintain/achieve a BMI between 18.5 and 24.9 kg/m2 and a waist circumference <40 inches for men and <35 inches for women.

Weight loss, Excessive Alcohol Intake, Stress

Many experts also recommend the following additional lifestyle modifications:

• Limitation of alcohol intake to one or two drinks per day
• Stress management