Diet and lifestyle interventions for CVD prevention

Dietary habits and their influence on CVD risk have been extensively reviewed and the European guidelines for CVD prevention and for the management of dyslipidaemias state that dietary modifications should form the basis for CVD prevention1,2,3.

Some dietary modifications directly result in measurable changes in blood cholesterol levels (see Table 2), as well as in BP and BMI. Even where changes in these risk factors are not observed, dietary modifications still appear to make an important contribution to CVD prevention1,2,3.

Table 2: Modified from the 2019 ESC/EAS Guidelines for the management of dyslipidaemias2

Lifestyle interventions to reduce LDL-C levels Magnitude of the effect* Level of evidence** Recommendation
Avoid dietary trans fat
++
A
Avoid any consumption of trans fat
Reduce dietary saturated fat
++
A
<10% of energy (<7% in case of hypercholesterolemia); fat intake predominantly from MUFAs and PUFAs
Increase dietary fibre
++
A
25-40 g/day, including ≥ 7-13 g soluble fibre
Use functional foods with added phytosterols
++
A
At least 2 g/day plant stanols/sterols
Use red yeast rice supplements
++
A
Nutraceuticals containing purified red yeast rice may be considered in people with elevated plasma cholesterol concentrations who do not qualify for treatment with statins in view of their global CVD risk
Reduce excessive body weight
++
A
BMI 20-25 kg/m2 wais circumference <94 cm (men) and <80 cm (women)
Reduce dietary cholesterol
+
B
Cholesterol intake should b e reduced (<300 mg/day), particularly in people with high plasma cholesterol levels
Increase habitual physical activity
+
B
3.5-7 h moderately vigorous physical activity per week or 30-60 min most days

* The magnitude of the effect (++= 5-10%; + = <5%) and the level of evidence refer to the impact of each dietary modification on plasma levels of a specific lipoprotein class.
** A=Data derived from multiple randomised clinical trials or meta-analyses, B=Data derived from a single randomised clinical trial or large non-randomised studies

Test your knowledge
Name three dietary components that are emphasized for their ability to lower serum cholesterol:
  1. Plant sterols/stanols
  2. Insoluble dietary fibre
  3. Soluble dietary fibre
  4. Quality of dietary fats, i.e., replacing saturated with unsaturated fatty acids
  5. Nuts, fish, and fish oil
Check your answer