What lifestyle modifications should I recommend to patients at risk of atherosclerosis?

For patients at risk of developing atherosclerosis, lifestyle modifications are crucial and should be advised and supported in line with general behaviour change approaches ¹.

• Dietary Changes:

  Patients should be advised to follow a cardioprotective diet, aiming for total fat intake to be 30% or less of total energy intake, with saturated fats making up 7% or less ¹. Where possible, saturated fats should be replaced by mono-unsaturated and polyunsaturated fats ¹. Specifically, increasing mono-unsaturated fat intake with olive oil, rapeseed oil, or spreads based on these oils is recommended for food preparation ¹. A Mediterranean-style diet, which includes more bread, fruit, vegetables, and fish, less meat, and replacing butter and cheese with plant oil-based products, is also advised ². Dietary advice should be tailored to the individual's circumstances, including any drug treatments or comorbidities ¹,². It is important not to routinely recommend eating oily fish solely for preventing another myocardial infarction (MI), nor to offer or advise the use of omega-3 fatty acid capsules or supplemented foods for prevention ². Additionally, patients should not take supplements containing beta-carotene, antioxidant supplements (vitamin E and/or C), or folic acid to reduce cardiovascular risk ². An individual consultation should be offered to discuss current eating habits and provide consistent, tailored advice that can be extended to the whole family ².

• Physical Activity:

  Patients should be advised to engage in aerobic and muscle-strengthening activities according to the UK Chief Medical Officers' physical activity guidelines ¹. For those who have had an MI, the advice is to undertake regular physical activity sufficient to increase exercise capacity, aiming for 20 to 30 minutes a day to the point of slight breathlessness ². Patients who are not currently active at this level should increase their activity gradually, starting at a comfortable level and increasing duration and intensity as fitness improves ². For individuals unable to perform moderate intensity physical activity due to comorbidity, medical conditions, or personal circumstances, they should be encouraged to exercise at their maximum safe capacity ¹. Advice on physical activity should always consider the person's needs, preferences, and circumstances ¹,².

• Smoking Cessation:

  Assessing a patient's readiness to make changes to their lifestyle, including smoking, is a key component of reducing cardiovascular disease risk ¹.

• Alcohol Consumption:

  For advice on alcohol consumption, patients should be referred to the UK government drinking guidelines ².

• Communication and Support:

  Adequate time should be set aside during consultations to provide information on risk assessment and answer questions, with further consultations arranged if needed ¹. It is important to explore the patient's beliefs about their health and assess their readiness and confidence to make lifestyle changes ¹. Involving the patient in developing a shared management plan and ensuring they understand the discussions are crucial steps ¹.