Lifestyle Interventions to Modify Cardiovascular Disease Risk

Researchers using whole-body magnetic resonance angiography have found an alarmingly high prevalence of asymptomatic atherosclerosis (49.4% of participants had at least one stenotic vessel and 27% had multiple stenotic vessels) in people considered to be at low to intermediate risk for cardiovascular disease.1 Atheroma develops over time, and subclinical disease is present before clinical symptoms are apparent.1

Atherosclerotic plaque, narrowed vessels, blood pressure, and cholesterol are all known risk factors for cardiovascular events,2 the leading cause of death in the US.3 However, with early detection and interventions to address modifiable lifestyle factors, atherosclerosis and cardiovascular disease (CVD) can be slowed or reversed.

In the following video, IFM educator Elizabeth Boham, MD, MS, RD, talks about the importance of personalized lifestyle factors like diet, exercise, and sleep for these at-risk patients:

Elizabeth Boham, MD, MS, RD, is board certified in family medicine and is a registered dietitian.
Dietary Interventions

A 2010 study suggests that a broader adherence to recommendations for the daily intake of fruit, vegetables, fish, and fatty acid composition may take away as much as 20-30% of the burden of CVD and result in approximately one extra year of life for a 40-year-old individual.4 Evidence suggests that healthy eating may affect CVD-related outcomes. Treating the gut using diet, probiotics, prebiotics, and other therapies may reduce risks for many cardiometabolic patients. IFM’s Cardiometabolic Food Plan, which is taught at the Cardiometabolic Advanced Practice Module (APM), is an easily personalized patient education resource.

In 2017, an international panel concluded that a healthy lifestyle, including the Mediterranean, DASH, Nordic, or vegetarian diet, is crucial for the prevention or delay of the onset of metabolic syndrome, CVD, and type 2 diabetes.5 Western-type diets, which are characterized by a high intake of red meat, processed foods, refined grains, sugars, and saturated fatty acids, have been associated with a higher prevalence of metabolic syndrome in women.6 A prospective analysis conducted within the Atherosclerosis Risk in Communities study indicated an 18% greater risk of incident metabolic syndrome for individuals with the highest Western dietary pattern score.7

In 2018, a study among Asian Indians living in the US suggested that a “Western/non-vegetarian” dietary pattern is associated with a metabolomic profile that is related to an adverse cardiometabolic profile.8 A September 2018 study suggested that the prevalence of metabolic syndrome, obesity, elevated high sensitivity C-reactive protein, and glucose intolerance increase as diet-related inflammation increases.9

Movement and Sleep

In addition to diet, regular physical activity has been shown to reduce the risk of prevalent diseases such as metabolic syndrome, CVD, and type 2 diabetes.10 A 2018 study found that high-velocity circuit resistance training improved biological markers, health-related quality of life, and overall CVD risk in adults with cardiometabolic syndrome and CVD risk factors.11 Another study in frail, obese older adults found that lifestyle interventions associated with weight loss improved cardiometabolic risk factors, but continued improvement in insulin sensitivity was only achieved when exercise was added to weight loss.12

More and more research has accumulated connecting sleep quality/quantity and overall health. A 2016 review of 75 studies investigating associations between sleep variables and measures of abdominal adiposity, glucose homeostasis, blood lipids, blood pressure, and inflammatory markers suggests that inadequate sleep may play a role in cardiometabolic risk at a later age for children and adolescents.13

A 2018 study in postmenopausal women suggests that sleep quality is an important correlate of insulin resistance in this population, regardless of whether they have metabolic syndrome.14 The study calls for further research to determine whether improving sleep improves insulin resistance in those with an elevated cardiometabolic risk.14 A similar study, in children and adolescents from Bogotá DC, Colombia, showed that boys who met the recommended duration of sleep had a decreased risk of elevated blood glucose levels.15 Poor sleep quality was related to lower HDL-c and higher triglyceride levels in girls, suggesting the clinical importance of improving sleep hygiene to reduce metabolic risk factors in children and adolescents.15

What Next?

To learn more about ways to help patients modify cardiometabolic risk through lifestyle interventions, consider IFM’s Cardiometabolic Advanced Practice Module (APM).  Within this module, 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.

Another cardiometabolic clinician resource is IFM’s Exploring Functional Medicine (EFM) online course, which provides an overview of Functional Medicine through the lens of a cardiometabolic case. With an emphasis on treating underlying causes, advanced physical exam techniques, and ready-to-use intake, assessment, and patient education tools, this course equips clinicians with the skills needed to immediately personalize prevention and treatment plans.

Explore more articles about cardiometabolic conditions


  1. Lambert MA, Weir-McCall JR, Salsano M, et al. Prevalence and distribution of atherosclerosis in a low- to intermediate-risk population: assessment with whole-body MR angiography. Radiology. 2018;287(3):795-804. doi:10.1148/radiol.2018171609.
  2. Bhatt DL, Eagle KA, Ohman EM, et al. Comparative determinants of 4-year cardiovascular event rates in stable outpatients at risk of or with atherothrombosis. JAMA. 2010;304(12):1350-1357. doi:10.1001/jama.2010.1322.
  3. Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation. 2016;133(4):e38-360. doi:10.1161/CIR.0000000000000350.
  4. Engelfriet P, Hoekstra J, Hoogenveen R, Büchner F, van Rossum C, Verschuren M. Food and vessels: the importance of a healthy diet to prevent cardiovascular disease. Eur J Cardiovasc Prev Rehabil. 2010;17(1):50-55. doi:10.1097/HJR.0b013e32832f3a76.
  5. Pérez-Martinez P, Mikhailidis DP, Athyros VG, et al. Lifestyle recommendations for the prevention and management of metabolic syndrome: an international panel recommendation. Nutr Rev. 2017;75(5):307-326. doi:10.1093/nutrit/nux014.
  6. Esmaillzadeh A, Kimiagar M, Mehrabi Y, Azadbakht L, Hu FB, Willett WC. Dietary patterns, insulin resistance, and prevalence of the metabolic syndrome in women. Am J Clin Nutr. 2007;85(3):910-918. doi:10.1093/ajcn/85.3.910.
  7. Lutsey PL, Steffen LM, Stevens J. Dietary intake and the development of the metabolic syndrome: the Atherosclerosis Risk in Communities study. Circulation. 2008;117(6):754-761. doi:10.1161/CIRCULATIONAHA.107.716159.
  8. Bhupathiraju SN, Guasch-Ferré M, Gadgil MD, et al. Dietary patterns among Asian Indians living in the United States have distinct metabolomic profiles that are associated with cardiometabolic risk. J Nutr. 2018;148(7):1150-1159. doi:10.1093/jn/nxy074.
  9. Mazidi M, Shivappa N, Wirth MD, et al. Dietary inflammatory index and cardiometabolic risk in US adults. Atherosclerosis. 2018;276:23-27. doi:10.1016/j.atherosclerosis.2018.02.020.
  10. Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: the evidence. CMAJ. 2006;174(6):801-809. doi:10.1503/cmaj.051351.
  11. Robertson KB, Potiaumpai M, Widdowson K, et al. Effects of high-velocity circuit resistance and treadmill training on cardiometabolic risk, blood markers, and quality of life in older adults. Appl Physiol Nutr Metab. 2018;43(8):822-832. doi:10.1139/apnm-2017-0807.
  12. Bouchonville M, Armamento-Villareal R, Shah K, et al. Weight loss, exercise or both and cardiometabolic risk factors in obese older adults: results of a randomized controlled trial. Int J Obes. 2014;38(3):423-431. doi:10.1038/ijo.2013.122.
  13. Quist JS, Sjödin A, Chaput JP, Hjorth MF. Sleep and cardiometabolic risk in children and adolescents. Sleep Med Rev. 2016;29:76-100. doi:10.1016/j.smrv.2015.09.001.
  14. Kline CE, Hall MH, Buyssee DJ, Earnest CP, Church TS. Poor sleep quality is associated with insulin resistance in postmenopausal women with and without metabolic syndrome. Metab Syndr Relat Disord. 2018;16(4):183-189. doi:10.1089/met.2018.0013.
  15. Pulido-Arjona L, Correa-Bautista JE, Agostinis-Sobrinho C, et al. Role of sleep duration and sleep-related problems in the metabolic syndrome among children and adolescents. Ital J Pediatr. 2018;44(1):9. doi:10.1186/s13052-018-0451-7.

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