Heart Diseases—Prevention

Physical Activity

It should come as no surprise that physical activity is directly related to lowering the risk of CVD. The mechanism for lowering cardiovascular risk is due to improved oxygen transport and reduced myocardial oxygen demand due to lowered systolic blood [Page 817]pressure and decreased resting heart rate. The effect of physical activity appears to be graded, that is, the risk of coronary disease decreases in a stepwise fashion as the intensity of the activity is increased. General consensus defines adequate physical activity as lasting 20 minutes or more of brisk walking, for about five times a week without pauses.

Diet and Alcohol

It has been shown in multiple studies that a diet high in fruits and vegetables contribute to a lower risk of cardiovascular disease, namely MI and stroke. Also, a high fiber diet can substantially reduce the risk of cardiovascular complications. Dietary fat is also an important contributor to CVD, and it appears that the type of fat ingested is more important than the total amount of fat. Trans fatty acids are associated with a higher incidence of coronary heart disease, while polyunsaturated fat and monounsaturated fat decreases this incidence. Fish consumption, due to its high amount of omega-3 fatty acids, also has been shown in randomized trials to lower the incidence of cardiovascular disease. Recent news has focused on the role of alcohol in lowering CVD risk. Moderate consumption of alcohol, that is one drink per day for women and two drinks per day for men have shown to decrease cardiovascular mortality. As should be expected, excessive intake of alcohol substantially increases the risk of stroke.

Psychosocial Factors

A reduction in the psychosocial stressors in life contributed to a reduction in cardiovascular risk. These factors included depression, stress at work or home, financial stress, and feeling of control.

Smoking

Multiple studies and meta-analysis have shown the importance of smoking cessation in preventing cardiovascular disease, making smoking the largest preventable cause of death. Smoking not only increases blood pressure and heart rate, but at the biological level, it causes endothelial injury, platelet activation and coronary plaque destabilization. Significant benefits are seen after smoking cessation at one year, decreasing the risk of MI and death from cardiovascular disease by one-half; while cessation at three years equals the cardiovascular risk from that of a nonsmoker.

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