Guidelines for a Heart-Healthy Lifestyle

Guideline Watch |
November 12, 2013

Guidelines for a Heart-Healthy Lifestyle

  1. JoAnne M. Foody, MD

New ACC/AHA recommendations are based primarily on the effects of diet and physical activity on lipid levels and blood pressure.

  1. JoAnne M. Foody, MD

Sponsoring Organizations: American College of Cardiology, American Heart Association

Target Population: Primary care providers

Background and Objective

The ACC/AHA Task Force based these recommendations on an evidence review of the relationship between dietary patterns, nutrient intake, and physical activity and cardiovascular disease (CVD) in adults conducted by an Expert Work Group convened by the National Heart, Lung, and Blood Institute. The Work Group developed three critical questions to define the scope of the review:

1. What is the effect of dietary patterns, macronutrients, or both on CVD risk factors?

2. What is the effect of dietary intake of sodium and potassium on CVD risk factors and outcomes?

3. What is the effect of physical activity on blood pressure (BP) and lipids compared with no treatment or with other types of interventions?

Key Points

  • The authors recommend consumption of a diet rich in vegetables, fruits, and whole grains and incorporating low-fat dairy products. Recommended protein sources include fish, legumes, and poultry; recommended sources of fats include vegetable oils and nuts.

  • They identify three plans that exemplify this dietary pattern: DASH, the USDA Food Pattern, and the AHA Diet.

  • Additional recommendations for lowering LDL include a dietary pattern that derives 5% to 6% of calories from saturated fat and a reduction in the percentage of calories from trans fats.

  • Additional recommendations for lowering BP include restriction of sodium intake to no more than 2400 mg per day — and, if possible, to 1500 mg per day. Evidence exists that reduction in sodium intake of approximately 1000 mg per day reduces CVD events by approximately 30%.

  • The DASH dietary pattern has been shown to be beneficial for reducing BP in a wide range of subgroups, including women and men; African-American and non–African-American adults; older and younger adults; and hypertensive and nonhypertensive individuals.

  • Recommendations for physical activity to reduce LDL, non-HDL cholesterol, and BP include three to four sessions of moderate-to-vigorous–intensity aerobic activity per week, lasting an average of 40 minutes per session.


These new guidelines consolidate and harmonize recommendations spread among several previous guidelines supporting an intensified use of diet — particularly a DASH-like diet — and physical activity to improve lipid and blood pressure control. Presumably, this will lead to improved cardiovascular outcomes, although studies of the effects of lifestyle interventions on hard outcomes are scarce and sorely needed. More importantly, the guidelines do not address the issue of implementation. To promote meaningful practice change, we need to develop and test strategies for ensuring patient adherence.

Editor Disclosures at Time of Publication

  • Disclosures for JoAnne M. Foody, MD at time of publication Consultant / Advisory board Aegerion; Amarin; Bristol-Myers Squibb; Janssen; Merck; Pfizer; sanofi-aventis Leadership positions in professional societies American College of Cardiology (Cardiosmart, Co-Chair)


Reader Comments (9)

Tariq J. Faridi B.Sc., M. Ed

Excellent Patient Educational Points for Heart Disease

namita tiwari Resident

This is an excellent recommendation that needs earliest intervention to make a change in someones health (primary level of intervention)

Neville Wilson MB, ChB, D.Fam. Med., D. Obs (COG) SA., M.Sc. Physician, Family Medicine/General Practice, Leinster Clinic, Ireland

These recommendations continue to ignore the benefits of saturated fats for cardiac health and protection. Saturated fats improve HDL levels, and LDL-C is not a proven risk factor for heart disease. There is no proven health benefit from reducing dietary cholesterol or saturated fat intake. Dr. Neville Wilson.

MIKAEL RABAEUS Physician, Preventive Medicine, Switzerland

The fundamental error in the 6 key points exposed is that diet and physical activity have as a purpose to lower cholesterol and BP. That means forgetting that f.ex. the Lyon Diet Heart Study showed a highly significant decrease in hard end-points WITHOUT any difference in cholesterol levels between the groups. This has also been shown for moderate hypertension.
And the same is true for physical activity. Cholesterol has strictly no predictive value when you correct for physical activity. Period.
So the real message should be: adopt a healthy lifestyle and forget about your cholesterol.

ouandyin Physician, Cardiology, China

We have lots of dietary patterns.and for patients,it is difficult to choose the right food,the food is too much.

Akpen Tivlumun

lovely piece

raman kesava

very interesting topic

RAVI BATHINA Physician, Cardiology, South Adian Heart Center

suggest use of Social Media Net Works to promote awareness

G. Bryant Hudson, PhD Other, Other, Lawrence Livermore National Lab (retired)

I believe there is considerable evidence that suggests nitrate from dietary sources may be significant in this context. Nitrate could easily be a principal factor in the success of the DASH diet. Accordingly, there are a collection of vegetables (leafy greens) that could be of special importance in our diet.

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