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Education in Heart
Comparison of lifestyle changes and pharmacological treatment on cardiovascular risk factors
  1. Pedro Marques-Vidal
  1. Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
  1. Correspondence to Dr Pedro Marques-Vidal, Department of Medicine, Internal Medicine, Centre Hospitalier Universitaire Vaudois Departement de Medecine, Lausanne 1011, Switzerland; pedro.marquesvidal{at}gmail.com

https://doi.org/10.1136/heartjnl-2019-316252

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    Learning objectives

    • The metabolic benefits associated with stopping smoking.

    • The effect of different types of diet on metabolic profile and clinical outcomes.

    • The protective components of diet.

    • The benefits associated with exercise.

    Chapters 2.7.1 and 2.7.2 of the ESC curriculum.

    Introduction

    Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in Europe and worldwide.1 The major modifiable risk factors (obesity, hypertension, smoking, dyslipidaemia and diabetes) are well known and guidelines regarding their management have been issued.2–6 All guidelines focus on the importance of lifestyle changes, which should be implemented before or in conjunction with drug therapy. Still, most studies show that implementation of a healthy lifestyle is far from optimal, a significant percentage of patients with CVD risk factors reporting no change at all.7 8

    The effects of lifestyle changes, alone or in conjunction with medical treatment, on CVD risk factors are seldom put forward. In this paper, we will make a brief overview of the effect of lifestyle changes (smoking cessation, adopting a healthier diet and increasing physical activity (PA)) on CVD risk factors (high blood pressure (BP), dyslipidaemia and hyperglycaemia) and compare them with the effect of pharmacological treatment. As smoking cessation per se is the most powerful lifestyle determinant of CVD,9 only the effects of smoking cessation on other risk factors will be assessed.

    Main text

    High BP

    The results of lifestyle changes and of antihypertensive drug treatments on BP levels are summarised in table 1, and comparison between lifestyle and drug effects is provided in figure 1A (for systolic blood pressure (SBP)) and figure 1B (for diastolic blood pressure (DBP)).

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    Table 1

    Effect of lifestyle and drug interventions on blood pressure levels

    Figure 1

    Comparison between lifestyle and drug effects on systolic (A) and diastolic (B) blood pressure levels. DASH, Dietary Approach to Stop Hypertension; HT, hypertensive subjects.

    Weight loss …

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    Footnotes

    • Collaborators Pollyanna Patriota.

    • Contributors PMV conceived the work, acquired and interpreted the data, wrote the manuscript and gave his final approval. PMV is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Provenance and peer review Commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article

    • Author note References which include a * are considered to be key references.