Skip to main content

Advertisement

Log in

Lifestyle Medicine and the Management of Cardiovascular Disease

  • Public Health Policy (E Klodas, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Evidence has clearly demonstrated the importance of lifestyle factors (e.g., diet, physical activity, smoking) in the development of cardiovascular disease (CVD). Interventions targeting these behaviors may improve outcomes for CVD patients. The aim of this review is to summarize the effects of lifestyle interventions in individuals with established CVD.

Recent Findings

Most recent trials focused on diet, physical activity, stress reduction, or a combination of these. Findings were mixed, but most interventions improved at least some markers of cardiovascular risk. Few studies measured long-term clinical outcomes, but some suggested a possible benefit of stress reduction and multifaceted interventions on cardiovascular events.

Summary

The benefits of lifestyle change for CVD patients have been established by decades of evidence. However, further research is needed to determine the optimal intensity, duration, and mode of delivery for interventions. Additional studies with long-term follow-up and measurement of clinical outcomes are also needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

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

  1. National Center for Health Statistics. Health US, 2015. With Special Feature on Racial and Ethnic Health Disparities. Hyattsville, MD; 2016.

  2. Keys A, Menotti A, Aravanis C, Blackburn H, Djordevic BS, Buzina R, et al. The seven countries study: 2,289 deaths in 15 years. Prev Med. 1984;13:141–54.

    Article  CAS  PubMed  Google Scholar 

  3. Menotti A, Keys A, Kromhout D, Blackburn H, Aravanis C, Bloemberg B, et al. Inter-cohort differences in coronary heart disease mortality in the 25-year follow-up of the seven countries study. Eur J Epidemiol. 1993;9(5):527–36.

    Article  CAS  PubMed  Google Scholar 

  4. Verschuren WM, Jacobs DR, Bloemberg BP, Kromhout D, Menotti A, Aravanis C, et al. Serum total cholesterol and long-term coronary heart disease mortality in different cultures. Twenty-five-year follow-up of the seven countries study. JAMA. 1995;274(2):131–6.

    Article  CAS  PubMed  Google Scholar 

  5. Benfante R. Studies of cardiovascular disease and cause-specific mortality trends in Japanese-American men living in Hawaii and risk factor comparisons with other Japanese populations in the Pacific region: a review. Hum Biol. 1992;64(6):791–805.

    CAS  PubMed  Google Scholar 

  6. Robertson TL, Kato H, Rhoads GG, Kagan A, Marmot M, Syme SL, et al. Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California. Incidence of myocardial infarction and death from coronary heart disease. Am J Cardiol. 1977;39(2):239–43.

    Article  CAS  PubMed  Google Scholar 

  7. Worth RM, Kato H, Rhoads GG, Kagan K, Syme SL. Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: mortality. Am J Epidemiol. 1975;102(6):481–90.

    Article  CAS  PubMed  Google Scholar 

  8. Micha RPJ, Cudhea F, Imamura F, Rehm CD, Mozaffarian D. Association between dietary factors and mortality from heart disease, stroke, and type 2 diabetes in the United States. JAMA. 2017;317(9):912–24. https://doi.org/10.1001/jama.2017.0947.

    Article  PubMed  Google Scholar 

  9. Lee DC, Pate R, Lavie CJ, Sui X, Church TS, Blair SN. Leisure-time running reduces all-cause and cardiovascular mortality risk. J Am Coll Cardiol. 2014;64(5):472–81. https://doi.org/10.1016/j.jacc.2014.04.058.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Katzmarzyk PT. Standing and mortality in a prospective cohort of Canadian adults. Med Sci Sports Exerc. 2014;46(5):940–6. https://doi.org/10.1249/MSS.0000000000000198.

    Article  PubMed  Google Scholar 

  11. Messner B, Bernhard D. Smoking and cardiovascular disease: mechanisms of endothelial dysfunction and early atherogenesis. Arterioscler Thromb Vasc Biol. 2014;34(3):509–15. https://doi.org/10.1161/atvbaha.113.300156.

    Article  CAS  PubMed  Google Scholar 

  12. O'Keefe JH, Bhatti SK, Bajwa A, DiNicolantonio JJ, Lavie CJ. Alcohol and cardiovascular health: the dose makes the poison...or the remedy. Mayo Clin Proc. 2014;89(3):382–93. https://doi.org/10.1016/j.mayocp.2013.11.005.

    Article  PubMed  CAS  Google Scholar 

  13. Steptoe A, Kivimaki M. Stress and cardiovascular disease: an update on current knowledge. Annu Rev Public Health. 2013;34:337–54. https://doi.org/10.1146/annurev-publhealth-031912-114452.

    Article  PubMed  Google Scholar 

  14. Covassin N, Singh P. Sleep duration and cardiovascular disease risk: epidemiologic and experimental evidence. Sleep Med Clin. 2016;11(1):81–9. https://doi.org/10.1016/j.jsmc.2015.10.007.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Valtorta NK, Kanaan M, Gilbody S, Ronzi S, Hanratty B. Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart. 2016;102(13):1009–16. https://doi.org/10.1136/heartjnl-2015-308790.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Anthony D. Diagnosis and screening of coronary artery disease. Prim Care. 2005;32(4):931–46.

    Article  PubMed  Google Scholar 

  17. Poredos P. Endothelial dysfunction and cardiovascular disease. Pathophysiol Haemost Thromb. 2002;32(5–6):274–7.

    CAS  PubMed  Google Scholar 

  18. Zieman SJ, Melenovsky V, Kass DA. Mechanisms, pathophysiology, and therapy of arterial stiffness. Arterioscler Thromb Vasc Biol. 2005;25(5):932–43.

    Article  CAS  PubMed  Google Scholar 

  19. Martinez-Gonzalez MA, Salas-Salvado J, Estruch R, Corella D, Fito M, Ros E. Benefits of the Mediterranean diet: insights from the PREDIMED study. Prog Cardiovasc Dis. 2015;58(1):50–60. https://doi.org/10.1016/j.pcad.2015.04.003.

    Article  PubMed  Google Scholar 

  20. Rees K, Hartley L, Flowers N, Clarke A, Hooper L, Thorogood M et al. ‘Mediterranean’ dietary pattern for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2013(8):Cd009825. https://doi.org/10.1002/14651858.

  21. Saneei P, Salehi-Abargouei A, Esmaillzadeh A, Azadbakht L. Influence of dietary approaches to stop hypertension (DASH) diet on blood pressure: a systematic review and meta-analysis on randomized controlled trials. Nutr Metab Cardiovasc Dis. 2014;24(12):1253–61. https://doi.org/10.1016/j.numecd.2014.06.008.

    Article  CAS  PubMed  Google Scholar 

  22. Estruch R, Ros E, Salas-Salvado J, Covas MI, Corella D, Aros F, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368(14):1279–90.

    Article  CAS  PubMed  Google Scholar 

  23. Hills AP, Mokhtar N, Byrne NM. Assessment of physical activity and energy expenditure: an overview of objective measures. Front Nutr. 2014;1:5. https://doi.org/10.3389/fnut.2014.00005.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Roberts CK, Little JP, Thyfault JP. Modification of insulin sensitivity and glycemic control by activity and exercise. Med Sci Sports Exerc. 2013;45(10):1868–77. https://doi.org/10.1249/MSS.0b013e318295cdbb.

    Article  CAS  PubMed  Google Scholar 

  25. Cornelissen VASN. Exercise training for blood pressure: a systematic review and meta-analysis. J Am Heart Assoc. 2013;2(1):e004473. https://doi.org/10.1161/JAHA.112.004473.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Ahmed HM, Blaha MJ, Nasir K, Rivera JJ, Blumenthal RS. Effects of physical activity on cardiovascular disease. Am J Cardiol. 2012;109(2):288–95. https://doi.org/10.1016/j.amjcard.2011.08.042.

    Article  PubMed  Google Scholar 

  27. Pate R, Pratt M, Blair S, Haskell W, Macera C, Bouchard C, et al. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995;273:402–7.

    Article  CAS  PubMed  Google Scholar 

  28. Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39(8):1423–34.

    Article  PubMed  Google Scholar 

  29. Fagard RH. Exercise characteristics and the blood pressure response to dynamic physical training. Med Sci Sports Exerc. 2001;33(6 Suppl):S484–92. discussion S93-4

    Article  CAS  PubMed  Google Scholar 

  30. Thompson PD, Buchner D, Pina IL, Balady GJ, Williams MA, Marcus BH, et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the council on clinical cardiology (subcommittee on exercise, rehabilitation, and prevention) and the council on nutrition, physical activity, and metabolism (subcommittee on physical activity). Circulation. 2003;107(24):3109–16. https://doi.org/10.1161/01.cir.0000075572.40158.77.

    Article  PubMed  Google Scholar 

  31. •• Anderson L, Oldridge N, Thompson DR, Zwisler AD, Rees K, Martin N, et al. Exercise-based cardiac rehabilitation for coronary heart disease: cochrane systematic review and meta-analysis. J Am Coll Cardiol. 2016;67(1):1–12. https://doi.org/10.1016/j.jacc.2015.10.044. Recent meta-analysis of exercise-baed cardiac rehabilitation.

    Article  PubMed  Google Scholar 

  32. World Health Organization. WHO global report: mortality attributable to tobacco. 2012. 2012. http://apps.who.int/iris/bitstream/10665/44815/1/9789241564434_eng.pdf. Accessed 19 July 2017.

  33. U.S. Department of Health and Human Services. How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease: a report of the Surgeon General. 2010. https://www.ncbi.nlm.nih.gov/books/NBK53017/. Accessed 19 July 2017.

  34. Talhout R, Schulz T, Florek E, van Benthem J, Wester P, Opperhuizen A. Hazardous compounds in tobacco smoke. Int J Environ Res Public Health. 2011;8(2):613–28. https://doi.org/10.3390/ijerph8020613.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Gopal DM, Kalogeropoulos AP, Georgiopoulou VV, Smith AL, Bauer DC, Newman AB, et al. Cigarette smoking exposure and heart failure risk in older adults: the health, aging, and body composition study. Am Heart J. 2012;164(2):236–42. https://doi.org/10.1016/j.ahj.2012.05.013.

    Article  PubMed  PubMed Central  Google Scholar 

  36. McEvoy JW, Nasir K, DeFilippis AP, Lima JA, Bluemke DA, Hundley WG, et al. Relationship of cigarette smoking with inflammation and subclinical vascular disease: the multi-ethnic study of atherosclerosis. Arterioscler Thromb Vasc Biol. 2015;35(4):1002–10. https://doi.org/10.1161/atvbaha.114.304960.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Hisamatsu T, Miura K, Arima H, Kadota A, Kadowaki S, Torii S, et al. Smoking, smoking cessation, and measures of subclinical atherosclerosis in multiple vascular beds in Japanese men. J Am Heart Assoc. 2016;5(9) https://doi.org/10.1161/jaha.116.003738.

  38. Kianoush S, Yakoob MY, Al-Rifai M, DeFilippis AP, Bittencourt MS, Duncan BB, et al. Associations of cigarette smoking with subclinical inflammation and atherosclerosis: ELSA-Brasil (The Brazilian Longitudinal Study of Adult Health). J Am Heart Assoc. 2017;6(6) https://doi.org/10.1161/jaha.116.005088.

  39. Steptoe A, Kivimaki M. Stress and cardiovascular disease. Nat Rev Cardiol. 2012;9(6):360–70. https://doi.org/10.1038/nrcardio.2012.45.

    Article  CAS  PubMed  Google Scholar 

  40. Mostofsky E, Maclure M, Sherwood JB, Tofler GH, Muller JE, Mittleman MA. Risk of acute myocardial infarction after the death of a significant person in one’s life: the determinants of myocardial infarction onset study. Circulation. 2012;125(3):491–6. https://doi.org/10.1161/circulationaha.111.061770.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould KL, Merritt TA, et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998;280(23):2001–7.

    Article  CAS  PubMed  Google Scholar 

  42. Ravera A, Carubelli V, Sciatti E, Bonadei I, Gorga E, Cani D et al. Nutrition and cardiovascular disease: finding the perfect recipe for cardiovascular health. Nutrients. 2016;8(6). https://doi.org/10.3390/nu8060363.

  43. Sacks FM, Obarzanek E, Windhauser MM, Svetkey LP, Vollmer WM, McCullough M, et al. Rationale and design of the dietary approaches to stop hypertension trial (DASH). A multicenter controlled-feeding study of dietary patterns to lower blood pressure. Ann Epidemiol. 1995;5(2):108–18.

    Article  CAS  PubMed  Google Scholar 

  44. Steinberg D, Bennett GG, Svetkey L. The DASH diet, 20 years later. JAMA. 2017;317(15):1529–30. https://doi.org/10.1001/jama.2017.1628.

    Article  PubMed  Google Scholar 

  45. Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Houston Miller N, Hubbard VS, 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(25 Suppl 2):S76–99. https://doi.org/10.1161/01.cir.0000437740.48606.d1.

    Article  PubMed  Google Scholar 

  46. Trichopoulou A, Bamia C, Trichopoulos D. Anatomy of health effects of Mediterranean diet: Greek EPIC prospective cohort study. BMJ. 2009;338:b2337.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Kendall CW, Jenkins DJ. A dietary portfolio: maximal reduction of low-density lipoprotein cholesterol with diet. Curr Atheroscler Rep. 2004;6(6):492–8.

    Article  PubMed  Google Scholar 

  48. Jenkins DJ, Kendall CW, Marchie A, Faulkner DA, Wong JM, de Souza R, et al. Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein. JAMA. 2003;290:502–10.

    Article  CAS  PubMed  Google Scholar 

  49. Song M, Fung TT, Hu FB, Willett WC, Longo VD, Chan AT, et al. Association of animal and plant protein intake with all-cause and cause-specific mortality. JAMA Intern Med. 2016;176(10):1453–63. https://doi.org/10.1001/jamainternmed.2016.4182.

    Article  PubMed  PubMed Central  Google Scholar 

  50. de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation. 1999;99(6):779–85.

    Article  PubMed  Google Scholar 

  51. Martinez-Gonzalez MA, Toledo E, Aros F, Fiol M, Corella D, Salas-Salvado J, et al. Extravirgin olive oil consumption reduces risk of atrial fibrillation: the PREDIMED (Prevencion con Dieta Mediterranea) trial. Circulation. 2014;130(1):18–26. https://doi.org/10.1161/circulationaha.113.006921.

    Article  CAS  PubMed  Google Scholar 

  52. Toledo E, Hu FB, Estruch R, Buil-Cosiales P, Corella D, Salas-Salvado J, et al. Effect of the Mediterranean diet on blood pressure in the PREDIMED trial: results from a randomized controlled trial. BMC Med. 2013;11:207. https://doi.org/10.1186/1741-7015-11-207.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Delgado-Lista J, Perez-Martinez P, Garcia-Rios A, Alcala-Diaz JF, Perez-Caballero AI, Gomez-Delgado F, et al. CORonary diet intervention with olive oil and cardiovascular PREVention study (the CORDIOPREV study): rationale, methods, and baseline characteristics: a clinical trial comparing the efficacy of a Mediterranean diet rich in olive oil versus a low-fat diet on cardiovascular disease in coronary patients. Am Heart J. 2016;177:42–50. https://doi.org/10.1016/j.ahj.2016.04.011.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Gomez-Delgado F, Garcia-Rios A, Alcala-Diaz JF, Rangel-Zuniga O, Delgado-Lista J, Yubero-Serrano EM, et al. Chronic consumption of a low-fat diet improves cardiometabolic risk factors according to the CLOCK gene in patients with coronary heart disease. Mol Nutr Food Res. 2015;59(12):2556–64. https://doi.org/10.1002/mnfr.201500375.

    Article  CAS  PubMed  Google Scholar 

  55. Gomez-Delgado F, Alcala-Diaz JF, Garcia-Rios A, Delgado-Lista J, Ortiz-Morales A, Rangel-Zuniga O, et al. Polymorphism at the TNF-alpha gene interacts with Mediterranean diet to influence triglyceride metabolism and inflammation status in metabolic syndrome patients: from the CORDIOPREV clinical trial. Mol Nutr Food Res. 2014;58(7):1519–27. https://doi.org/10.1002/mnfr.201300723.

    Article  CAS  PubMed  Google Scholar 

  56. Blumenthal JA, Babyak MA, Hinderliter A, Watkins LL, Craighead L, Lin PH, et al. Effects of the DASH diet alone and in combination with exercise and weight loss on blood pressure and cardiovascular biomarkers in men and women with high blood pressure: the ENCORE study. Arch Intern Med. 2010;170(2):126–35.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Paula TP, Viana LV, Neto AT, Leitao CB, Gross JL, Azevedo MJ. Effects of the DASH diet and walking on blood pressure in patients with type 2 diabetes and uncontrolled hypertension: a randomized controlled trial. J Clin Hyperten (Greenwich). 2015;17(11):895–901. https://doi.org/10.1111/jch.12597.

    Article  Google Scholar 

  58. Miller GFCE, Leroy Z, Wallin R. Prevalence and costs of five chronic conditions in children. J Sch Nurs. 2016;32(5):357–64. https://doi.org/10.1177/1059840516641190.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Ferdowsian HR, Barnard ND. Effects of plant-based diets on plasma lipids. Am J Cardiol. 2009;104(7):947–56. https://doi.org/10.1016/j.amjcard.2009.05.032.

    Article  PubMed  CAS  Google Scholar 

  60. Ornish D, Brown S, Scherwitz L. Can lifestyle changes reverse coronary heart disease? The lifestyle heart trial. Lancet. 1990;336:129–33.

    Article  CAS  PubMed  Google Scholar 

  61. Horrigan BJ. Ornish and Pritikin programs approved by CMS. Explore (New York, NY). 2010;6(6):346–8. https://doi.org/10.1016/j.explore.2010.08.007.

    Article  Google Scholar 

  62. Jenkins DJ, Kendall CW, Marchie A, Faulkner D, Vidgen E, Lapsley KG, et al. The effect of combining plant sterols, soy protein, viscous fibers, and almonds in treating hypercholesterolemia. Metabolism. 2003;52(11):1478–83.

    Article  CAS  PubMed  Google Scholar 

  63. Jenkins DJ, Josse AR, Wong JM, Nguyen TH, Kendall CW. The portfolio diet for cardiovascular risk reduction. Curr Atheroscler Rep. 2007;9(6):501–7.

    Article  CAS  PubMed  Google Scholar 

  64. Jenkins DJ, Jones PJ, Frohlich J, Lamarche B, Ireland C, Nishi SK, et al. The effect of a dietary portfolio compared to a DASH-type diet on blood pressure. Nutr Metab Cardiovasc Dis. 2015;25(12):1132–9. https://doi.org/10.1016/j.numecd.2015.08.006.

    Article  CAS  PubMed  Google Scholar 

  65. Flammer AJ, Sudano I, Wolfrum M, Thomas R, Enseleit F, Periat D, et al. Cardiovascular effects of flavanol-rich chocolate in patients with heart failure. Eur Heart J. 2012;33(17):2172–80. https://doi.org/10.1093/eurheartj/ehr448.

    Article  CAS  PubMed  Google Scholar 

  66. Rodriguez-Leyva D, Weighell W, Edel AL, LaVallee R, Dibrov E, Pinneker R, et al. Potent antihypertensive action of dietary flaxseed in hypertensive patients. Hypertension. 2013;62(6):1081–9. https://doi.org/10.1161/HYPERTENSIONAHA.113.02094.

    Article  CAS  PubMed  Google Scholar 

  67. Jamshed H, Sultan FA, Iqbal R, Gilani AH. Dietary almonds increase serum HDL cholesterol in coronary artery disease patients in a randomized controlled trial. J Nutr. 2015;145(10):2287–92. https://doi.org/10.3945/jn.114.207944.

    Article  CAS  PubMed  Google Scholar 

  68. Chen CY, Holbrook M, Duess MA, Dohadwala MM, Hamburg NM, Asztalos BF, et al. Effect of almond consumption on vascular function in patients with coronary artery disease: a randomized, controlled, cross-over trial. Nutr J. 2015;14:61. https://doi.org/10.1186/s12937-015-0049-5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Schwingshackl L, Hoffmann G, Missbach B, Stelmach-Mardas M, Boeing H. An umbrella review of nuts intake and risk of cardiovascular disease. Curr Pharm Des. 2017;23(7):1016–27. https://doi.org/10.2174/1381612822666161010121356.

    Article  CAS  PubMed  Google Scholar 

  70. Ried K, Fakler P, Stocks NP. Effect of cocoa on blood pressure. Cochrane Database Syst Rev. 2017;4:CD008893. https://doi.org/10.1002/14651858.CD008893.pub3.

    PubMed  Google Scholar 

  71. Karjalainen JJ, Kiviniemi AM, Hautala AJ, Piira OP, Lepojarvi ES, Perkiomaki JS, et al. Effects of physical activity and exercise training on cardiovascular risk in coronary artery disease patients with and without type 2 diabetes. Diabetes Care. 2015;38(4):706–15. https://doi.org/10.2337/dc14-2216.

    PubMed  Google Scholar 

  72. Miura Y, Fukumoto Y, Miura T, Shimada K, Asakura M, Kadokami T, et al. Impact of physical activity on cardiovascular events in patients with chronic heart failure. A multicenter prospective cohort study. Circ J. 2013;77(12):2963–72.

    Article  PubMed  Google Scholar 

  73. Chen CH, Chen YJ, Tu HP, Huang MH, Jhong JH, Lin KL. Benefits of exercise training and the correlation between aerobic capacity and functional outcomes and quality of life in elderly patients with coronary artery disease. Kaohsjung J Med Sci. 2014;30(10):521–30. https://doi.org/10.1016/j.kjms.2014.08.004.

    CAS  Google Scholar 

  74. Pattyn N, Coeckelberghs E, Buys R, Cornelissen VA, Vanhees L. Aerobic interval training vs. moderate continuous training in coronary artery disease patients: a systematic review and meta-analysis. Sports Med. 2014;44(5):687–700. https://doi.org/10.1007/s40279-014-0158-x.

    Article  PubMed  Google Scholar 

  75. Conraads VM, Pattyn N, De Maeyer C, Beckers PJ, Coeckelberghs E, Cornelissen VA, et al. Aerobic interval training and continuous training equally improve aerobic exercise capacity in patients with coronary artery disease: the SAINTEX-CAD study. Int J Cardiol. 2015;179:203–10. https://doi.org/10.1016/j.ijcard.2014.10.155.

    Article  PubMed  Google Scholar 

  76. Malmo V, Nes BM, Amundsen BH, Tjonna AE, Stoylen A, Rossvoll O, et al. Aerobic interval training reduces the burden of atrial fibrillation in the short term: a randomized trial. Circulation. 2016;133(5):466–73. https://doi.org/10.1161/CIRCULATIONAHA.115.018220.

    Article  PubMed  Google Scholar 

  77. Mohanty S, Mohanty P, Tamaki M, Natale V, Gianni C, Trivedi C, et al. Differential association of exercise intensity with risk of atrial fibrillation in men and women: evidence from a meta-analysis. J Cardiovasc Electrophysiol. 2016;27(9):1021–9. https://doi.org/10.1111/jce.13023.

    Article  PubMed  Google Scholar 

  78. Skielboe AK, Bandholm TQ, Hakmann S, Mourier M, Kallemose T, Dixen U. Cardiovascular exercise and burden of arrhythmia in patients with atrial fibrillation—a randomized controlled trial. PLoS One. 2017;12(2):e0170060. https://doi.org/10.1371/journal.pone.0170060.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  79. Ellingsen O, Halle M, Conraads V, Stoylen A, Dalen H, Delagardelle C, et al. High-intensity interval training in patients with heart failure with reduced ejection fraction. Circulation. 2017;135(9):839–49. https://doi.org/10.1161/CIRCULATIONAHA.116.022924.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Nagele E, Jeitler K, Horvath K, Semlitsch T, Posch N, Herrmann KH, et al. Clinical effectiveness of stress-reduction techniques in patients with hypertension: systematic review and meta-analysis. J Hypertens. 2014;32(10):1936–1944; discussion 44. https://doi.org/10.1097/HJH.0000000000000298.

    Article  CAS  PubMed  Google Scholar 

  81. Rainforth MV, Schneider RH, Nidich SI, Gaylord-King C, Salerno JW, Anderson JW. Stress reduction programs in patients with elevated blood pressure: a systematic review and meta-analysis. Curr Hypertens Rep. 2007;9(6):520–8.

    Article  PubMed  PubMed Central  Google Scholar 

  82. Duraimani S, Schneider RH, Randall OS, Nidich SI, Xu S, Ketete M, et al. Effects of lifestyle modification on telomerase gene expression in hypertensive patients: a pilot trial of stress reduction and health education programs in African Americans. PLoS One. 2015;10(11):e0142689. https://doi.org/10.1371/journal.pone.0142689.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  83. Schneider RH, Grim CE, Rainforth MV, Kotchen T, Nidich SI, Gaylord-King C, et al. Stress reduction in the secondary prevention of cardiovascular disease: randomized, controlled trial of transcendental meditation and health education in blacks. Circ Cardiovasc Qual Outcomes. 2012;5(6):750–8. https://doi.org/10.1161/CIRCOUTCOMES.112.967406.

    Article  PubMed  Google Scholar 

  84. Blom K, Baker B, How M, Dai M, Irvine J, Abbey S, et al. Hypertension analysis of stress reduction using mindfulness meditation and yoga: results from the HARMONY randomized controlled trial. Am J Hypertens. 2014;27(1):122–9. https://doi.org/10.1093/ajh/hpt134.

    Article  PubMed  Google Scholar 

  85. de Fatima Rosas Marchiori M, Kozasa EH, Miranda RD, Monezi Andrade AL, Perrotti TC, Leite JR. Decrease in blood pressure and improved psychological aspects through meditation training in hypertensive older adults: a randomized control study. Geriatr Gerontol Int. 2015;15(10):1158–64. https://doi.org/10.1111/ggi.12414.

    Article  PubMed  Google Scholar 

  86. • Blumenthal JA, Sherwood A, Smith PJ, Watkins L, Mabe S, Kraus WE, et al. Enhancing cardiac rehabilitation with stress management training: a randomized, clinical efficacy trial. Circulation. 2016;133(14):1341–50. https://doi.org/10.1161/CIRCULATIONAHA.115.018926. Trial of stress management reporting long-term clinical outcomes.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Sherwood A, Blumenthal JA, Koch GG, Hoffman BM, Watkins LL, Smith PJ, et al. Effects of coping skills training on quality of life, disease biomarkers, and clinical outcomes in patients with heart failure: a randomized clinical trial. Circ Heart Fail. 2017;10(1) https://doi.org/10.1161/CIRCHEARTFAILURE.116.003410.

  88. Huikuri HV, Stein PK. Heart rate variability in risk stratification of cardiac patients. Prog Cardiovasc Dis. 2013;56(2):153–9. https://doi.org/10.1016/j.pcad.2013.07.003.

    Article  PubMed  Google Scholar 

  89. Tyagi A, Cohen M. Yoga and heart rate variability: a comprehensive review of the literature. Int J Yoga. 2016;9(2):97–113. https://doi.org/10.4103/0973-6131.183712.

    Article  PubMed  PubMed Central  Google Scholar 

  90. Wolever RQ, Bobinet KJ, McCabe K, Mackenzie ER, Fekete E, Kusnick CA, et al. Effective and viable mind-body stress reduction in the workplace: a randomized controlled trial. J Occup Health Psychol. 2012;17(2):246–58. https://doi.org/10.1037/a0027278.

    Article  PubMed  Google Scholar 

  91. Pedersen LR, Olsen RH, Jurs A, Astrup A, Chabanova E, Simonsen L, et al. A randomised trial comparing weight loss with aerobic exercise in overweight individuals with coronary artery disease: the CUT-IT trial. Eur J Prev Cardiol. 2015;22(8):1009–17. https://doi.org/10.1177/2047487314545280.

    Article  PubMed  Google Scholar 

  92. Pedersen LR, Olsen RH, Anholm C, Walzem RL, Fenger M, Eugen-Olsen J, et al. Weight loss is superior to exercise in improving the atherogenic lipid profile in a sedentary, overweight population with stable coronary artery disease: a randomized trial. Atherosclerosis. 2016;246:221–8. https://doi.org/10.1016/j.atherosclerosis.2016.01.001.

    Article  CAS  PubMed  Google Scholar 

  93. • Kitzman DW, Brubaker P, Morgan T, Haykowsky M, Hundley G, Kraus WE, et al. Effect of caloric restriction or aerobic exercise training on peak oxygen consumption and quality of life in obese older patients with heart failure with preserved ejection fraction: a randomized clinical trial. JAMA. 2016;315(1):36–46. https://doi.org/10.1001/jama.2015.17346. Assessed independent and combined effects of caloric restriction and exercise in heart failure.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  94. Gallagher R, Kirkness A, Zelestis E, Hollams D, Kneale C, Armari E, et al. A randomised trial of a weight loss intervention for overweight and obese people diagnosed with coronary heart disease and/or type 2 diabetes. Ann Behav Med. 2012;44(1):119–28. https://doi.org/10.1007/s12160-012-9369-2.

    Article  PubMed  Google Scholar 

  95. Miller ER 3rd, Cooper LA, Carson KA, Wang NY, Appel LJ, Gayles D, et al. A dietary intervention in urban African Americans: results of the “five plus nuts and beans” randomized trial. Am J Prev Med. 2016;50(1):87–95. https://doi.org/10.1016/j.amepre.2015.06.010.

    Article  PubMed  Google Scholar 

  96. • Chow CK, Redfern J, Hillis GS, Thakkar J, Santo K, Hackett ML, et al. Effect of lifestyle-focused text messaging on risk factor modification in patients with coronary heart disease: a randomized clinical trial. JAMA. 2015;314(12):1255–63. https://doi.org/10.1001/jama.2015.10945. Evaluation of a low-cost text-message-based intervention.

    Article  CAS  PubMed  Google Scholar 

  97. Ijzelenberg W, Hellemans IM, van Tulder MW, Heymans MW, Rauwerda JA, van Rossum AC, et al. The effect of a comprehensive lifestyle intervention on cardiovascular risk factors in pharmacologically treated patients with stable cardiovascular disease compared to usual care: a randomised controlled trial. BMC Cardiovasc Disord. 2012;12:71. https://doi.org/10.1186/1471-2261-12-71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  98. • Hua K, Hao G, Li W. Cardiovascular outcomes of lifestyle intervention in hypertensive patients with antihypertensive agents. Int J Cardiol. 2017;227:751–6. https://doi.org/10.1016/j.ijcard.2016.10.062. Large RCT reporting long-term clinical outcomes.

    Article  PubMed  Google Scholar 

  99. Saffi MA, Polanczyk CA, Rabelo-Silva ER. Lifestyle interventions reduce cardiovascular risk in patients with coronary artery disease: a randomized clinical trial. Eur J Cardiovasc Nurs. 2014;13(5):436–43. https://doi.org/10.1177/1474515113505396.

    Article  PubMed  Google Scholar 

  100. Alharbi M, Gallagher R, Kirkness A, Sibbritt D, Tofler G. Long-term outcomes from healthy eating and exercise lifestyle program for overweight people with heart disease and diabetes. Eur J Cardiovasc Nurs. 2016;15(1):91–9. https://doi.org/10.1177/1474515114557222.

    Article  PubMed  Google Scholar 

  101. Pfaeffli Dale L, Whittaker R, Jiang Y, Stewart R, Rolleston A, Maddison R. Text message and internet support for coronary heart disease self-management: results from the Text4Heart randomized controlled trial. J Med Internet Res. 2015;17(10):e237. https://doi.org/10.2196/jmir.4944.

    Article  PubMed  PubMed Central  Google Scholar 

  102. Abed HS, Wittert GA, Leong DP, Shirazi MG, Bahrami B, Middeldorp ME, et al. Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: a randomized clinical trial. JAMA. 2013;310(19):2050–60. https://doi.org/10.1001/jama.2013.280521.

    Article  CAS  PubMed  Google Scholar 

  103. Mahmood SS, Levy D, Vasan RS, Wang TJ. The Framingham heart study and the epidemiology of cardiovascular disease: a historical perspective. Lancet. 2014;383(9921):999–1008. https://doi.org/10.1016/S0140-6736(13)61752-3.

    Article  PubMed  Google Scholar 

  104. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291(10):1238–45.

    Article  PubMed  Google Scholar 

  105. Ford ES, Bergmann MM, Kroger J, Schienkiewitz A, Weikert C, Boeing H. Healthy living is the best revenge: findings from the European prospective investigation into cancer and nutrition-Potsdam study. Arch Intern Med. 2009;169(15):1355–62.

    Article  PubMed  Google Scholar 

  106. •• Schwingshackl L, Schwedhelm C, Hoffmann G, Lampousi AM, Knuppel S, Iqbal K, et al. Food groups and risk of all-cause mortality: a systematic review and meta-analysis of prospective studies. Am J Clin Nutr. 2017;105(6):1462–73. https://doi.org/10.3945/ajcn.117.153148. Latest meta-analysis of associations between dietary factors and mortality.

    PubMed  Google Scholar 

  107. Khera AV, Emdin CA, Drake I, Natarajan P, Bick AG, Cook NR, et al. Genetic risk, adherence to a healthy lifestyle, and coronary disease. N Engl J Med. 2016;375(24):2349–58. https://doi.org/10.1056/NEJMoa1605086.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  108. Jorgensen T, Jacobsen RK, Toft U, Aadahl M, Glumer C, Pisinger C. Effect of screening and lifestyle counselling on incidence of ischaemic heart disease in general population: Inter99 randomised trial. BMJ. 2014;348:g3617. https://doi.org/10.1136/bmj.g3617.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  109. Katz DL. Lifestyle is the medicine, culture is the spoon. AJLM. 2014;8(5):301–5.

    Google Scholar 

  110. Katz DL, Colino S. Disease proof. New York: Hudson Street Press; 2013.

    Google Scholar 

  111. Massar SAA, Liu JCJ, Mohammad NB, Chee MWL. Poor habitual sleep efficiency is associated with increased cardiovascular and cortisol stress reactivity in men. Psychoneuroendocrinology. 2017;81:151–6. https://doi.org/10.1016/j.psyneuen.2017.04.013.

    Article  PubMed  Google Scholar 

  112. Hargens TA, Kaleth AS, Edwards ES, Butner KL. Association between sleep disorders, obesity, and exercise: a review. Nat Sci Sleep. 2013;5:27–35. https://doi.org/10.2147/NSS.S34838.

    Article  PubMed  PubMed Central  Google Scholar 

  113. Jousilahti P, Laatikainen T, Salomaa V, Pietila A, Vartiainen E, Puska P. 40-year CHD mortality trends and the role of risk factors in mortality decline: the North Karelia project experience. Glob Heart. 2016;11(2):207–12. https://doi.org/10.1016/j.gheart.2016.04.004.

    Article  PubMed  Google Scholar 

  114. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403. https://doi.org/10.1056/NEJMoa012512.

    Article  CAS  PubMed  Google Scholar 

  115. Katz DL, Frates EP, Bonnet JP, Gupta SK, Vartiainen E, Carmona RH. Lifestyle as medicine: the case for a true health initiative. Am J Health Promot. 2017;890117117705949 https://doi.org/10.1177/0890117117705949.

  116. Katz DL, Meller S. Can we say what diet is best for health? Annu Rev Public Health. 2014;35:83–103. https://doi.org/10.1146/annurev-publhealth-032013-182351.

    Article  CAS  PubMed  Google Scholar 

  117. • Sacks FM, Lichtenstein AH, Wu JHY, Appel LJ, Creager MA, Kris-Etherton PM, et al. Dietary fats and cardiovascular disease: a presidential advisory from the American Heart Association. Circulation. 2017; https://doi.org/10.1161/CIR.0000000000000510. Recent AHA scientific statement on dietary fats and cardiovascular risk.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to David L. Katz.

Ethics declarations

Conflict of Interest

Kimberly N. Doughty, Nelson X. Del Pilar, Amanda Audette, and David L. Katz declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Public Health Policy

Electronic supplementary material

ESM 1

(DOCX 27 kb)

ESM 2

(DOCX 20 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Doughty, K.N., Del Pilar, N.X., Audette, A. et al. Lifestyle Medicine and the Management of Cardiovascular Disease. Curr Cardiol Rep 19, 116 (2017). https://doi.org/10.1007/s11886-017-0925-z

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11886-017-0925-z

Keywords

Navigation