What lifestyle modifications should I recommend to patients at high risk for coronary artery disease?

For patients at high risk of coronary artery disease, lifestyle modifications are crucial for reducing their risk ¹,³. It is important to advise and support patients to achieve a healthy lifestyle, acknowledging that changing lifelong habits can be difficult and that gradual, sustained change is often more permanent ¹,². Assess their readiness, concerns, and confidence to make changes to their lifestyle ¹,².

Key lifestyle modifications to recommend include:

• Diet:
  • Advise a diet where total fat intake is 30% or less of total energy intake, and saturated fats are 7% or less, replacing saturated fats with mono-unsaturated and polyunsaturated fats where possible ².
  • Encourage increasing mono-unsaturated fat intake using olive oil, rapeseed oil, or spreads based on these oils in food preparation ¹,².
  • Recommend eating at least 4 to 5 portions per week of unsalted nuts, seeds, and legumes ¹.
  • Advise consuming at least two portions of fish per week, including a portion of oily fish ¹.
  • Encourage at least 5 portions of fruit and vegetables per day ¹.
  • Promote a fibre intake of 30-45g per day, choosing wholegrain varieties of starchy foods ¹.
  • Advise reducing sugar and food products containing refined sugars ¹.
  • Recommend reducing salt intake to less than 6g per day, avoiding adding it at the table, and minimising processed foods ¹.
  • A Mediterranean-style diet (more bread, fruit, vegetables, and fish; less meat; replacing butter and cheese with plant oil-based products) is also advised ⁴.
  • Do not routinely recommend dietary supplements, including omega-3 capsules, plant sterols, or supplemented foods, as there is no good evidence they reduce CVD risk ¹,⁴. Also, do not recommend beta-carotene, antioxidant supplements (vitamin E and/or C), or folic acid to reduce cardiovascular risk ⁴.
• Physical Activity:
  • Advise at least 150 minutes per week of moderate intensity aerobic activity (to the point of slight breathlessness) or at least 75 minutes per week of vigorous intensity aerobic activity, or a mix ¹.
  • Encourage people who cannot perform moderate intensity activity due to comorbidities or medical conditions to exercise at their maximum safe capacity ².
  • Advise avoiding prolonged sedentary behaviour ¹.
  • Activity in bouts of 10 minutes or more is effective as long as the total weekly amount is achieved ¹.
  • Advise undertaking regular physical activity sufficient to increase exercise capacity, aiming for 20 to 30 minutes a day to the point of slight breathlessness, increasing gradually ⁴.
• Alcohol Consumption:
  • Advise keeping alcohol consumption within recommended limits: no more than 14 units per week for men and women, spread over 3 days or more ¹.
  • Encourage at least two alcohol-free days per week and avoiding binge drinking and intoxication ¹.
• Smoking Cessation:
  • Address smoking as a key lifestyle factor for CVD risk reduction ².
• Weight Management:
  • If obese, assess for symptoms of sleep apnoea and treat if appropriate ¹.
  • Optimise the management of obesity as a modifiable CVD risk factor ³.
• General Support:
  • Where possible, optimise the management of all other modifiable CVD risk factors, such as hypertension ³.
  • Consider arranging referrals to programmes such as exercise referral schemes or weight management services to support lifestyle changes ³.