Lifestyle Interventions to Modify Cardiovascular Disease Risk

Atherosclerotic plaque, narrowed vessels, hypertension, and elevated LDL cholesterol are all known risk factors for cardiovascular events that are among the leading causes of death in the US.¹ However, with early detection and interventions to address modifiable lifestyle factors, atherosclerosis and cardiovascular disease (CVD) progression may be slowed and stabilized.^2,3 A 2021 prospective study called the Cardiovascular Health Program (CHP) Registry found that personalized therapeutic lifestyle change resulted in substantial improvements in CVD risk factors (e.g., waist circumference, blood pressure, cholesterol, fasting glucose, and insulin resistance).⁴ Up to 50% of participants even reverted abnormal findings to normal findings. Furthermore, new medications and increased doses of medications occurred in only a very small proportion of the study’s participants.⁴

CVD prevention begins with careful assessment of risk factors, especially those risk factors that can be modified by therapeutic lifestyle change. In the following video, IFM educator Elizabeth Boham, MD, MS, RD, talks about the importance of functional medicine’s personalized lifestyle factors like diet, exercise, and sleep for at-risk patients:

(Video Time: 2 minutes) Dr. Elizabeth Boham is board certified in family medicine, with a strong background in nutrition and functional medicine. She speaks on topics ranging from women’s health and breast cancer prevention to insulin resistance and heart health.

Food as Fuel: Dietary Approaches

Numerous lines of evidence show that plant-based diets are associated with a reduction in cardiovascular diseases and a prolonged life span.⁵ Two long-term observational studies published in 2021 support the positive association between plant-based foods and cardiovascular health.^6,7 In addition, the Mediterranean diet and incorporating herbs and spices usually used in Mediterranean-style cooking (i.e., cinnamon, turmeric, ginger, cumin, saffron) has been associated with lower risk for cardiovascular disease⁸ and improvement of cardiometabolic measures.⁹ Following a Mediterranean diet may also help patients live longer. A 2024 meta-analysis of 28 studies (n=679,259 older adults) found that higher adherence to a Mediterranean diet reduced all-cause mortality risk by 23% and reduced cardiovascular-related mortality risk by 27%.¹⁰

What foods should patients avoid? Overall, research studies have linked pro-inflammatory diets with increased risk of CVD.¹¹ Consumption of ultra-processed foods and Western-type diets that are characterized by a high intake of red meat, refined grains, sugars, and saturated fatty acids have been associated with a higher prevalence of cardiovascular and cardiometabolic conditions and CVD mortality risk.^12-15 

Moving to Maintain Heart Health: Exercise Interventions

Sleep, sedentary behavior, and physical activity are each independently associated with cardiovascular health.¹⁶ Regular physical activity has been shown to reduce the risk of prevalent diseases such as metabolic syndrome, CVD, and type 2 diabetes.^17-19 According to the American Heart Association, moderate and vigorous aerobic activity, muscle strengthening through resistance training, increasing daily movement while decreasing sedentary behavior, and adding intensity to physical activity are among the recommendations for enhancing cardiorespiratory fitness in adults.²⁰ Flexibility and balance training are additional exercise strategies, and the benefits of specific exercise routines and activities, including Pilates, stretching, and yoga, continue to be studied to determine the full benefits of each on prevention and improvement of cardiovascular health.^21-24

A 2020 meta-analysis compared the effectiveness of high-intensity interval training (HIIT) versus moderate-intensity continuous training (MICT) in patients with hypertension and within cardiac rehabilitation programs.²⁵ Researchers found that both interventions increased the maximal oxygen uptake (VO₂max) for hypertensive patients compared to control groups and promoted a reduction in systolic blood pressure, while HIIT decreased diastolic blood pressure to a greater extent.²⁵ Investigators concluded that overall, HIIT may be more beneficial for improvement of cardiorespiratory fitness in hypertensive patients.²⁵

Sleep Quality & Duration: A Risk Factor for CVD

Much research has accumulated connecting sleep and overall health, including heart health, with epidemiological studies suggesting relationships between sleep quality/quantity and myocardial infarction, stroke, and metabolic syndrome.^26-29 Recent studies have found that among adults, both short (less than six hours) and long sleep (greater than eight hours) may increase the risk of metabolic syndrome by 15% and 19%, of obesity by 14% and 15%, and of high blood pressure by 16% and 13%, respectively.²⁹ In addition, studies suggest that people experiencing insomnia had a 69% higher risk of a heart attack compared to those without insomnia, especially those sleeping five hours or less.²⁶

Adequate sleep duration may be important for preventing cardiovascular diseases in modern society. In fact, a 2019 meta-analysis looking at the impact of daylight savings on heart health found that the risk of acute myocardial infarction increases modestly but significantly after the shift to daylight savings time.³⁰ The researchers speculate that the transition to daylight savings may cause a disruption of the circadian rhythm, which in turn induces changes in sleep quantity and quality, together with a predominance of sympathetic activity, an increase in pro-inflammatory cytokine levels, and a rise in heart rate and blood pressure.³⁰

Conclusion

As IFM educator Elizabeth Boham, MD, states in the video above, “When a patient comes to see me with atherosclerosis, I always focus on those personalized lifestyle factors first and foremost… They form the foundation of health.” 

A close working relationship between clinician and patient can help identify those lifestyle components from exercise to nutrition to sleep that may be most appropriate for a patient’s personalized and sustainable therapeutic strategy. IFM’s Cardiometabolic Functional Medicine Advanced Practice Module® (APM) teaches clinicians new approaches to effective assessments and treatments and how to integrate these lifesaving tools into practice. Clinicians will learn how to evaluate and utilize specific nutrients, phytonutrients, botanicals, pharmaceuticals, dietary plans, stress reduction techniques, and lifestyle interventions to improve the prevention and management of patients with hypertension, cardiovascular disease, metabolic syndrome, and type 2 diabetes.

As the research behind modifiable factors like diet and sleep continues to develop, clinicians are seeing new opportunities for safer and more effective interventions to prevent and address cardiovascular and metabolic diseases.