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Lifestyle changes to prevent cardio- and cerebrovascular disease at midlife: A systematic review

  • Birgit-Christiane Zyriax
    Correspondence
    Corresponding author at: Midwifery Science – Health Care Research and Prevention, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52 - Bldg. W26 – D-20246, Hamburg, Germany.
    Affiliations
    Midwifery Science – Health Care Research and Prevention, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
    Search for articles by this author
  • Eberhard Windler
    Affiliations
    Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
    Search for articles by this author
Published:September 23, 2022DOI:https://doi.org/10.1016/j.maturitas.2022.09.003

      Highlights

      • Increasing numbers of health behaviors are reported to be associated with lower cardiovascular risk.
      • A predominantly plant-based diet appears recommendable.
      • Substantial weight gain seems worth avoiding.
      • Higher cardiovascular fitness and brisk walking indicate lower risk of stroke.
      • Non-smoking and alcohol only in moderation are advisable.

      Abstract

      Cardio- and cerebrovascular diseases are leading causes of death and morbidity in ageing populations. While numerous cohort studies show inverse associations of presumably healthy lifestyles and cardiovascular risk factors, the causal link to many modifiable behaviors is still insufficiently evidence-based. Because of bias of studies and heterogeneity of results, we performed a systematic review of meta-analyses of randomized controlled trials and observational studies on lifestyle patterns including nutrition, physical activity, smoking, and weight versus incidence and mortality of cardio- and cerebrovascular diseases. A search string retrieved 624 references in PubMed covering the last five years. Two researchers screened titles and abstracts independently but with equivalent results. Nineteen references met the inclusion criteria. Results affirm that high adherence to plant-based diets, including components such as fruits, vegetables, legumes, whole grains, low-fat dairy, olive oil, nuts, and low intake of sodium, sweetened beverages, alcohol, and red and processed meats, results in lower risk of vascular outcomes in a dose-dependent manner. Physical activity quantified as walking pace or cardiorespiratory fitness yielded an inverse effect on stroke. Health measures such as smoking status, BMI and increase in body weight are associated with substantial risk of the incidence of and mortality from cardio- and cerebrovascular diseases, while strong adherence to an overall prudent lifestyle lowered the risk of cardiovascular disease by 66 % and that stroke by 60 %. In summary, increasing numbers of and adherence to health behaviors may markedly lower the burden of cardio- and cerebrovascular diseases. However, future research should focus on randomized controlled trials to test for causal relationships.

      Abbreviations:

      CVD (cardiovascular disease), CVDI (cardiovascular disease incidence), CVDM (cardiovascular disease mortality), CHD (coronary heart disease), CHDI (coronary heart disease incidence), CHDM (coronary heart disease mortality), STR (stroke), STRI (stroke incidence), STRM (stroke mortality), TM (total mortality), (risk reduced), (risk increased), n.s. (not significant), 95%CI (95 % confidence interval), MD (Mediterranean diet), DASH (Dietary Approaches to Stop Hypertension), CRF (cardiorespiratory fitness)

      Keywords

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