Advertisement

The Role of Healthy Lifestyle in the Primordial Prevention of Cardiovascular Disease

  • Steven A. Claas
  • Donna K. Arnett
Lipid Abnormalities and Cardiovascular Prevention (G De Backer, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Lipid Abnormalities and Cardiovascular Prevention

Abstract

Whereas primary prevention seeks to forestall development of disease in individuals with elevated risk, primordial prevention seeks to preempt the development of risk factors. Health behaviors—characterized as “lifestyle” factors—are key interventional targets in primordial prevention of cardiovascular disease. Appropriate dietary intake, including limiting salt and saturated fat consumption, can reduce the risk of developing hypertension and dyslipidemias. Regular physical activity is associated with lower blood pressure and healthier lipid profiles. Diet and exercise are critical to maintaining weight conducive to cardiovascular health. Behavioral factors such as stress management, sleep duration, portion control, and meal timing may play a role in weight management and offer additional routes of intervention. Any smoking elevates cardiovascular risk. Although lifestyle modification programs can be instrumental in reaching public health goals, maintaining cardiovascular health should not be a matter solely of willpower. Ideally, structural and social forces should make healthy lifestyles the default option.

Keywords

Primordial prevention Lifestyle Behavioral intervention Cardiovascular health 

Notes

Compliance with Ethical Standards

Conflict of Interest

Steven A. Claas and Donna K. Arnett declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This review article does not contain any previously unpublished data arising from studies of human or animal subjects performed by either of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.•
    Mozaffarian D, Benjamin EJ, Go AS, et al.: Heart Disease and Stroke Statistics-2016 update: a report from the American Heart Association. Circulation. 2015. The latest of the AHA’s yearly and definitive assessments of the state of CV health and disease in the US.Google Scholar
  2. 2.
    Labarthe DR. From cardiovascular disease to cardiovascular health: a quiet revolution? Circ Cardiovasc Qual Outcomes. 2012;5:e86–92.CrossRefPubMedGoogle Scholar
  3. 3.
    Strasser T. Reflections on cardiovascular diseases. Interdiscip Sci Rev. 1978;3:225–30.CrossRefGoogle Scholar
  4. 4.
    National Heart LaBI. Report of the task force on research in epidemiology and prevention of cardiovascular diseases. Washington, DC: National Institutes of Health, Public Health Service, US Department of Health and Human Services; 1994.Google Scholar
  5. 5.
    American College of Cardiology: CardioSmart. https://www.cardiosmart.org. Accessed 13 Jan 2016.
  6. 6.
    American Heart Association: My Life Check—Life’s Simple 7. http://www.heart.org/HEARTORG/Conditions/My-Life-Check---Lifes-Simple-7_UCM_471453_Article.jsp-.Vpl1CzaxH8s. Accessed 15 Jan 2016.
  7. 7.
    Weintraub WS, Daniels SR, Burke LE, et al. Value of primordial and primary prevention for cardiovascular disease: a policy statement from the American Heart Association. Circulation. 2011;124:967–90.CrossRefPubMedGoogle Scholar
  8. 8.
    Appleton AA, Buka SL, Loucks EB, et al. A prospective study of positive early-life psychosocial factors and favorable cardiovascular risk in adulthood. Circulation. 2013;127:905–12.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Stamler J. Dietary salt and blood pressure. Ann N Y Acad Sci. 1993;676:122–56.CrossRefPubMedGoogle Scholar
  10. 10.
    Mozaffarian D, Fahimi S, Singh GM, et al. Global sodium consumption and death from cardiovascular causes. N Engl J Med. 2014;371:624–34.CrossRefPubMedGoogle Scholar
  11. 11.
    Alderman MH, Cohen HW. Dietary sodium intake and cardiovascular mortality: controversy resolved? Am J Hypertens. 2012;25:727–34.CrossRefPubMedGoogle Scholar
  12. 12.
    Cook NR, Appel LJ, Whelton PK. Lower levels of sodium intake and reduced cardiovascular risk. Circulation. 2014;129:981–9.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Lloyd-Jones DM, Hong Y, Labarthe D, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic Impact Goal through 2020 and beyond. Circulation. 2010;121:586–613.CrossRefPubMedGoogle Scholar
  14. 14.
    Appel LJ, Baker DH, Bar-Or O, et al. Dietary reference intakes for water, potassium, sodium, chloride, and sulfate. Washington, DC: Institute of Medicine; 2005.Google Scholar
  15. 15.
    Ekmekcioglu C, Elmadfa I, Meyer AL et al. The role of dietary potassium in hypertension and diabetes. J Physiol Biochem. 2015.Google Scholar
  16. 16.
    Binia A, Jaeger J, Hu Y, et al. Daily potassium intake and sodium-to-potassium ratio in the reduction of blood pressure: a meta-analysis of randomized controlled trials. J Hypertens. 2015;33:1509–20.CrossRefPubMedGoogle Scholar
  17. 17.
    Aaron KJ, Sanders PW. Role of dietary salt and potassium intake in cardiovascular health and disease: a review of the evidence. Mayo Clin Proc. 2013;88:987–95.CrossRefPubMedGoogle Scholar
  18. 18.
    Kodavali L, Townsend RR. Alcohol and its relationship to blood pressure. Curr Hypertens Rep. 2006;8:338–44.CrossRefPubMedGoogle Scholar
  19. 19.
    Klatsky AL. Alcohol and cardiovascular diseases: where do we stand today? J Intern Med. 2015;278:238–50.CrossRefPubMedGoogle Scholar
  20. 20.
    2015-2020 dietary guidelines for Americans. US Department of Health and Human Services and US Department of Agriculture. 2015.Google Scholar
  21. 21.
    Obarzanek E, Sacks FM, Vollmer WM, et al. Effects on blood lipids of a blood pressure-lowering diet: the Dietary Approaches to Stop Hypertension (DASH) trial. Am J Clin Nutr. 2001;74:80–9.PubMedGoogle Scholar
  22. 22.
    Ginsberg HN, Kris-Etherton P, Dennis B, et al. Effects of reducing dietary saturated fatty acids on plasma lipids and lipoproteins in healthy subjects: the DELTA Study, protocol 1. Arterioscler, Thromb, Vasc Biol. 1998;18:441–9.CrossRefGoogle Scholar
  23. 23.
    Berglund L, Lefevre M, Ginsberg HN, et al. Comparison of monounsaturated fat with carbohydrates as a replacement for saturated fat in subjects with a high metabolic risk profile: studies in the fasting and postprandial states. Am J Clin Nutr. 2007;86:1611–20.PubMedGoogle Scholar
  24. 24.
    Mensink RP, Zock PL, Kester AD, et al. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr. 2003;77:1146–55.PubMedGoogle Scholar
  25. 25.
    Mozaffarian D, Clarke R. Quantitative effects on cardiovascular risk factors and coronary heart disease risk of replacing partially hydrogenated vegetable oils with other fats and oils. Eur J Clin Nutr. 2009;63 Suppl 2:S22–33.CrossRefPubMedGoogle Scholar
  26. 26.
    Magnussen CG, Niinikoski H, Juonala M, et al. When and how to start prevention of atherosclerosis? Lessons from the Cardiovascular Risk in the Young Finns Study and the Special Turku Coronary Risk Factor Intervention Project. Pediatr Nephrol. 2012;27:1441–52.CrossRefPubMedGoogle Scholar
  27. 27.
    Niinikoski H, Pahkala K, Ala-Korpela M, et al. Effect of repeated dietary counseling on serum lipoproteins from infancy to adulthood. Pediatrics. 2012;129:e704–13.CrossRefPubMedGoogle Scholar
  28. 28.
    Yang Q, Zhang Z, Gregg EW, et al. Added sugar intake and cardiovascular diseases mortality among US adults. JAMA internal medicine. 2014;174:516–24.CrossRefPubMedGoogle Scholar
  29. 29.
    Dhurandhar NV, Thomas D. The link between dietary sugar intake and cardiovascular disease mortality: an unresolved question. Jama. 2015;313:959–60.CrossRefPubMedGoogle Scholar
  30. 30.
    Jalal DI, Smits G, Johnson RJ, et al. Increased fructose associates with elevated blood pressure. J Am Soc Nephrol. 2010;21:1543–9.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Brown IJ, Stamler J, Van Horn L, et al. Sugar-sweetened beverage, sugar intake of individuals, and their blood pressure: international study of macro/micronutrients and blood pressure. Hypertension. 2011;57:695–701.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Malik AH, Akram Y, Shetty S, et al. Impact of sugar-sweetened beverages on blood pressure. Am J Cardiol. 2014;113:1574–80.CrossRefPubMedGoogle Scholar
  33. 33.
    Jayalath VH, de Souza RJ, Ha V, et al. Sugar-sweetened beverage consumption and incident hypertension: a systematic review and meta-analysis of prospective cohorts. Am J Clin Nutr. 2015;102:914–21.CrossRefPubMedGoogle Scholar
  34. 34.
    Stanhope KL, Medici V, Bremer AA, et al. A dose-response study of consuming high-fructose corn syrup-sweetened beverages on lipid/lipoprotein risk factors for cardiovascular disease in young adults. Am J Clin Nutr. 2015;101:1144–54.CrossRefPubMedGoogle Scholar
  35. 35.
    Raben A, Moller BK, Flint A et al. Increased postprandial glycaemia, insulinemia, and lipidemia after 10 weeks’ sucrose-rich diet compared to an artificially sweetened diet: a randomised controlled trial. Food Nutr Res. 2011; 55.Google Scholar
  36. 36.
    American Heart Association: Added sugars add to your risk of dying from heart disease. American Heart Association. http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/Added-Sugars-Add-to-Your-Risk-of-Dying-from-Heart-Disease_UCM_460319_Article.jsp. Accessed 15 Feb 2016.
  37. 37.
    Karanja NM, Obarzanek E, Lin PH, et al. Descriptive characteristics of the dietary patterns used in the Dietary Approaches to Stop Hypertension Trial. DASH Collaborative Research Group. J Am Diet Assoc. 1999;99:S19–27.CrossRefPubMedGoogle Scholar
  38. 38.
    American Heart Association: The American Heart Associations diet and lifestyle recommendations. http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyEating/The-American-Heart-Associations-Diet-and-Lifestyle-Recommendations_UCM_305855_Article.jsp. Accessed 12 Jan 2016.
  39. 39.
    Whelton SP, Chin A, Xin X, et al. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med. 2002;136:493–503.CrossRefPubMedGoogle Scholar
  40. 40.••
    Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:S76–99. This documents the AHA’s assessment of all lifestyle-based primordial and primary prevention interventions and the level of evidence associated with each. The 172-page full report is available online.CrossRefPubMedGoogle Scholar
  41. 41.
    Sousa N, Mendes R, Abrantes C, et al. A randomized 9-month study of blood pressure and body fat responses to aerobic training versus combined aerobic and resistance training in older men. Exp Gerontol. 2013;48:727–33.CrossRefPubMedGoogle Scholar
  42. 42.
    Kelley GA, Kelley KS, Tran ZV. Walking, lipids, and lipoproteins: a meta-analysis of randomized controlled trials. Prev Med. 2004;38:651–61.CrossRefPubMedGoogle Scholar
  43. 43.
    Kelley GA, Kelley KS, Tran ZV. Aerobic exercise and lipids and lipoproteins in women: a meta-analysis of randomized controlled trials. J Womens Health (Larchmt). 2004;13:1148–64.CrossRefGoogle Scholar
  44. 44.
    Kelley GA, Kelley KS, Tran ZV. Exercise, lipids, and lipoproteins in older adults: a meta-analysis. Prev Cardiol. 2005;8:206–14.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Kodama S, Tanaka S, Saito K, et al. Effect of aerobic exercise training on serum levels of high-density lipoprotein cholesterol: a meta-analysis. Arch Intern Med. 2007;167:999–1008.CrossRefPubMedGoogle Scholar
  46. 46.
    Committee PAGA. Physical activity guidelines advisory committee report, 2008. Washington, DC: US Department of Health and Human Services; 2008.Google Scholar
  47. 47.
    Kelley GA, Kelley KS. Impact of progressive resistance training on lipids and lipoproteins in adults: a meta-analysis of randomized controlled trials. Prev Med. 2009;48:9–19.CrossRefPubMedGoogle Scholar
  48. 48.
    Kelley GA, Kelley KS. Impact of progressive resistance training on lipids and lipoproteins in adults: another look at a meta-analysis using prediction intervals. Prev Med. 2009;49:473–5.CrossRefPubMedGoogle Scholar
  49. 49.
    Epel E, Lapidus R, McEwen B, et al. Stress may add bite to appetite in women: a laboratory study of stress-induced cortisol and eating behavior. Psychoneuroendocrinology. 2001;26:37–49.CrossRefPubMedGoogle Scholar
  50. 50.
    Rutters F, Nieuwenhuizen AG, Lemmens SG, et al. Acute stress-related changes in eating in the absence of hunger. Obesity (Silver Spring). 2009;17:72–7.CrossRefGoogle Scholar
  51. 51.
    Epel E, Jimenez S, Brownell K, et al. Are stress eaters at risk for the metabolic syndrome? Ann N Y Acad Sci. 2004;1032:208–10.CrossRefPubMedGoogle Scholar
  52. 52.
    Patel SR, Hu FB. Short sleep duration and weight gain: a systematic review. Obesity (Silver Spring). 2008;16:643–53.CrossRefGoogle Scholar
  53. 53.
    Benton D. Portion size: what we know and what we need to know. Crit Rev Food Sci Nutr. 2015;55:988–1004.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Steenhuis IH, Vermeer WM. Portion size: review and framework for interventions. Int J Behav Nutr Phys Act. 2009;6:58.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Peter Herman C, Polivy J, Pliner P, et al. Mechanisms underlying the portion-size effect. Physiol Behav. 2015;144:129–36.CrossRefPubMedGoogle Scholar
  56. 56.
    Reid KJ, Baron KG, Zee PC. Meal timing influences daily caloric intake in healthy adults. Nutr Res. 2014;34:930–5.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Bjartveit K, Tverdal A. Health consequences of smoking 1-4 cigarettes per day. Tob Control. 2005;14:315–20.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Lanza ST, Vasilenko SA. New methods shed light on age of onset as a risk factor for nicotine dependence. Addict Behav. 2015;50:161–4.CrossRefPubMedGoogle Scholar
  59. 59.
    Peirson L, Ali MU, Kenny M, et al. Interventions for prevention and treatment of tobacco smoking in school-aged children and adolescents: a systematic review and meta-analysis. Prev Med. 2015;85:20–31.CrossRefPubMedGoogle Scholar
  60. 60.
    My Life Check. American Heart Association. https://mlc.heart.org. Accessed 15 Jan 2016.
  61. 61.
  62. 62.
    Yang Q, Cogswell ME, Flanders WD, et al. Trends in cardiovascular health metrics and associations with all-cause and CVD mortality among US adults. Jama. 2012;307:1273–83.CrossRefPubMedGoogle Scholar
  63. 63.
    Folsom AR, Yatsuya H, Nettleton JA, et al. Community prevalence of ideal cardiovascular health, by the American Heart Association definition, and relationship with cardiovascular disease incidence. J Am Coll Cardiol. 2011;57:1690–6.CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Kulshreshtha A, Vaccarino V, Judd SE, et al. Life’s Simple 7 and risk of incident stroke: the reasons for geographic and racial differences in stroke study. Stroke. 2013;44:1909–14.CrossRefPubMedGoogle Scholar
  65. 65.
    Olson NC, Cushman M, Judd SE, et al. American Heart Association’s Life’s Simple 7 and risk of venous thromboembolism: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. J Am Heart Assoc. 2015;4:e001494.CrossRefPubMedPubMedCentralGoogle Scholar
  66. 66.
    Thacker EL, Gillett SR, Wadley VG, et al. The American Heart Association Life’s Simple 7 and incident cognitive impairment: The REasons for Geographic And Racial Differences in Stroke (REGARDS) study. J Am Heart Assoc. 2014;3:e000635.CrossRefPubMedPubMedCentralGoogle Scholar
  67. 67.
    Yang Q, Zhang B, Deng P, et al. Assessing cardiovascular health using Life’s Simple 7 in a Chinese population undergoing stroke prevention. Chin Med J (Engl). 2015;128:2450–6.CrossRefGoogle Scholar
  68. 68.
    Fretts AM, Howard BV, McKnight B, et al. Life’s Simple 7 and incidence of diabetes among American Indians: the strong heart family study. Diabetes Care. 2014;37:2240–5.CrossRefPubMedPubMedCentralGoogle Scholar
  69. 69.
    Brown DL, Conley KM, Sanchez BN, et al. A multicomponent behavioral intervention to reduce stroke risk factor behaviors: the stroke health and risk education cluster-randomized controlled trial. Stroke. 2015;46:2861–7.CrossRefPubMedGoogle Scholar
  70. 70.
    Shah A, Clayman ML, Glass S, et al. Protect your heart: a culture-specific multimedia cardiovascular health education program. J Health Commun. 2015;20:424–30.CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.••
    Pearson TA, Palaniappan LP, Artinian NT, et al. American Heart Association Guide for improving cardiovascular health at the community level, 2013 update: a scientific statement for public health practitioners, healthcare providers, and health policy makers. Circulation. 2013;127:1730–53. This describes the AHA’s rationales and recommendations for community-based primordial and primary prevention measures.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Department of Epidemiology, School of Public HealthUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.Dean’s Office, College of Public HealthUniversity of KentuckyLexingtonUSA

Personalised recommendations