Primary Prevention of Coronary Artery Disease through Lifestyle Changes

Introduction to Lifestyle Modifications

The American College of Cardiology recommends promoting a healthy lifestyle throughout life, including a heart-healthy diet, regular physical activity, smoking cessation, and maintaining a healthy body weight to prevent coronary artery disease 1

A varied diet that emphasizes vegetables, fruits, nuts, whole grains, lean vegetable or animal protein, and fish (especially oily fish at least twice weekly) is recommended for coronary artery disease prevention 1, 2
Minimizing intake of trans fats, red meat, processed red meats, refined carbohydrates, and sweetened beverages is advised for coronary artery disease prevention 1, 2
Moderate alcohol consumption is suggested for coronary artery disease prevention 3, 4

Engaging in at least 150 minutes per week of moderate-intensity physical activity or 75 minutes per week of vigorous-intensity physical activity is recommended for coronary artery disease prevention 1
Incorporating regular aerobic exercise into the routine is advised for coronary artery disease prevention 3, 4

Aiming for a healthy body weight with a body mass index (BMI) < 25 kg/m² is recommended for coronary artery disease prevention 3, 4
Avoiding central obesity (excess fat around the waistline) is advised for coronary artery disease prevention 3, 4
For individuals with overweight or obesity, counseling and caloric restriction are recommended for achieving and maintaining weight loss 1

Complete cessation of smoking is essential for coronary artery disease prevention 3, 5
Avoiding exposure to environmental tobacco smoke (secondhand smoke) is advised for coronary artery disease prevention 5
All adults should be assessed at every healthcare visit for tobacco use, and those who use tobacco should be assisted and strongly advised to quit 1

Aiming for blood pressure < 140 mm Hg systolic and < 85 mm Hg diastolic is recommended for coronary artery disease prevention 3, 4
Lifestyle modifications for blood pressure control include reducing sodium intake, increasing consumption of fruits and vegetables, and maintaining physical activity 2, 5

Targeting total cholesterol < 5.0 mmol/L (193 mg/dL) and LDL cholesterol < 3.0 mmol/L (116 mg/dL) is recommended for coronary artery disease prevention 3, 4
Dietary strategies to improve cholesterol include limiting saturated fat and dietary cholesterol while increasing intake of foods rich in soluble fiber 2

For those with diabetes, lifestyle changes including dietary improvements and meeting exercise recommendations are crucial for coronary artery disease prevention 1
Aiming for optimal glycemic control with HbA1c < 7% is recommended for coronary artery disease prevention 3, 4
Diabetes-specific targets include stricter blood pressure control (< 130/80 mmHg) 3, 4

Adults aged 40-75 years should undergo 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimation 1
Those at higher risk (>15% 10-year risk) may need more intensive lifestyle interventions and possibly medication 3, 4
Screening of first-degree blood relatives of patients with premature coronary heart disease is recommended 3, 4