Primary prevention of cardiovascular disease: focus on improving behavioral risk factors

Public health strategies for the detection, prevention and treatment of cardiovascular diseases (CVDs) can be implemented at many levels as follows: from individual behavioral alterations to population-based strategies that affect different national and cultural communities. Despite the fact that the priority of primary prevention is treating hypertension and hyperlipidemia, great importance is given to improving behavioral and biological risk factors. Dietary modification, exercise and smoking cessation are specific interventions that can be targeted to reduce CVD risk at both the individual and population levels. Following a healthy lifestyle can potentially change factors such as overweight/obesity, hyperlipidemia, type 2 diabetes, and hypertension. The aim of this review was to present and summarize new data on the primary cardiovascular prevention with a focus on improving behavioral risk factors considered in the current guidelines.

1. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease. JACC. 2019;74:e177-232. doi:10.1016/j.jacc.2019.03.010.

2. Piepoli MF, Hoes AW, Agewall S, et al. 2016 European guidelines on cardiovascular disease prevention in clinical practice: the sixth joint task force of the European society of cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts) developed with the special contribution of the European association for cardiovascular prevention & rehabilitation (EACPR). Eur Heart J. 2016;37:2315-81. doi:10.1093/eurheartj/ehw106.

3. Boytsov SA, Pogosova NV. Cardiovascular Prevention 2017. National Recommendations. Russ J Cardiol. 2018;(6):7-122 (In Russ.) doi:10.15829/1560-4071-2018-6-7-122.

4. Williams B, Mancia G, Spiering W, et al.; ESC Scientific Document Group. 2018 ESC/ESH guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European society of cardiology (ESC) and the European society of hypertension (ESH). Eur Heart J. 2018;39:3021-104. doi:10.1093/eurheartj/ehy339.

5. Stewart J, Addy K, Campbell S, Wilkinson P. Primary prevention of cardiovascular disease: Updated review of contemporary guidance and literature. JRSM Cardiovasc Dis. 2020;9:2048004020949326. doi:10.1177/2048004020949326.

6. Roth GA, Mensah GA, Johnson CO, et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study. J Am Coll Cardiol. 2020;76(25):2982-3021. doi:10.1016/j.jacc.2020.11.010.

7. Hackshaw A, Morris JK, Boniface S, et al. Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports. BMJ. 2018;360:j5855.

8. Ding N, Sang Y, Chen J, et al. Cigarette smoking, smoking cessation, and long-term risk of 3 major atherosclerotic diseases. J Am Coll Cardiol. 2019;74(4):498-507. doi:10.1016/j.jacc.2019.05.049.

9. Anthenelli RM, Benowitz NL, West R, et al. Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): a doubleblind, randomised, placebo-controlled clinical trial. Lancet. 2016;387:2507-20. doi:10.1016/S0140-6736(16)30272-0.

10. Hartmann-Boyce J, Hong B, Livingstone-Banks J, et al. Additional behavioural support as an adjunct to pharmacotherapy for smoking cessation. Cochrane Datab Syst Rev. 2019;6:1465-858. doi:10.1002/14651858.

11. Shields PG, Berman M, Brasky TM, et al. A review of pulmonary toxicity of electronic cigarettes in the context of smoking: a focus on inflammation. Cancer Epidemiol Biomarkers Prev. 2017;26:1175-91. doi:10.1158/1055-9965.EPI-17-0358.

12. Hom S, Chen L, Wang T, et al. Platelet activation, adhesion, inflammation, and aggregation potential are altered in the presence of electronic cigarette extracts of variable nicotine concentrations. Platelets. 2016;27:694-702. doi:10.3109/09537104.2016.1158403.

13. Nocella C, Biondi-Zoccai G, Sciarretta S, et al. Impact of tobacco versus electronic cigarette smoking on platelet function. Am J Cardiol. 2018;122:1477-81. doi:10.1016/j.amjcard.2018.07.029.

14. Moheimani RS, Bhetraratana M, Peters KM, et al. Sympathomimetic effects of acute E-cigarette use: role of nicotine and non-nicotine constituents. JAHA. 2017;6:e006579. doi:10.1161/JAHA.117.006579.

15. Hajek P, Phillips-Waller A, Przulj D, et al. Randomized trial of e-cigarettes versus nicotinereplacement therapy. N Engl J Med. 2019;380:629-37. doi:10.1007/s11606-020-06408-7.

16. Bell S, Daskalopoulou M, Rapsomaniki E, et al. Association between clinically recorded alcohol consumption and initial presentation of 12 cardiovascular diseases: population based cohort study using linked health records. BMJ. 2017;356:j909. doi:10.1136/bmj.j909.

17. Mukamal K, Lazo M. Alcohol and cardiovascular disease. BMJ. 2017;356:j1340. doi:10.1136/bmj.j1340.

18. Holmes MV, Dale CE, Zuccolo L, et al. Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data. BMJ. 2014;349:g4164. doi:10.1136/bmj.g4164.

19. Licaj I, Sandin S, Skeie G, et al. Alcohol consumption over time and mortality in the Swedish women’s lifestyle and health cohort. BMJ Open. 2016;6:e012862. doi:10.1136/bmjopen-2016-012862.

20. Horvat P, Stefler D, Murphy M, et al. Alcohol, pattern of drinking and all-cause mortality in Russia, Belarus and Hungary: a retrospective indirect cohort study based on mortality of relatives. Addiction. 2018;113(7):1252-63. doi:10.1111/add.14189.

21. Tharrey M, Mariotti F, Mashchak A, et al. Patterns of plant and animal protein intake are strongly associated with cardiovascular mortality: the Adventist Health Study-2 cohort. Int J Epidemiol. 2018;47:1603-12. doi:10.1093/ije/dyy030.

22. Satija A, Bhupathiraju SN, Spiegelman D, et al. Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults. J Am Coll Cardiol. 2017;70:411-22. doi:10.1016/j.jacc.2017.05.047.

23. Seidelmann SB, Claggett B, Cheng S, et al. Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis. Lancet Public Health. 2018;3:e419-28. doi:10.1016/S2468-2667(18)30135-X.

24. Tsygankova DP, Krivoshapova KЕ, Barbarash OL. The Mediterranean diet cardioprotective effects in different countries. Russian Journal of Cardiology. 2018;(6):207-11. (In Russ.). doi:10.15829/1560-4071-2018-6-207-211.

25. Estruch R, Ros E, Salas-Salvadó J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med. 2018;378(25):e34. doi:10.1056/NEJMoa1800389.

26. Suri S, Kumar V, Kumar S, et al. DASH Dietary Pattern: A Treatment for Non-communicable Diseases. Curr Hypertens Rev. 2020;16(2):108-14. doi:10.2174/1573402115666191007144608.

27. Shah B, Newman JD, Woolf K, et al. Anti-inflammatory effects of a vegan diet versus the American Heart Association-recommended diet in coronary artery disease trial. J Am Heart Assoc. 2018;7(23):e011367. doi:10.1161/JAHA.118.011367.

28. Ruegsegger GN, Booth FW. Health Benefits of Exercise. Cold Spring Harb Perspect Med. 2018;8(7):a029694. doi:10.1101/cshperspect.a029694.

29. Krivoshapova KE, Tsygankova DP, Barbarash OL. Physical inactivity as a risk factor for cardiovascular morbidity and mortality. Systemic Hypertension. 2018;15(3):14-20 (In Russ.). doi:10.26442/2075-082X_2018.3.14-20.

30. Ekelund U, Steene-Johannessen J, Brown WJ, et al. Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. Lancet. 2016;388:1302- 10. doi:10.1016/S0140-6736(16)30370-1.

31. Wahid A, Manek N, Nichols M, et al. Quantifying the association between physical activity and cardiovascular disease and diabetes: a systematic review and meta-analysis. J Am Heart Assoc. 2016;5:e002495. doi:10.1161/JAHA.115.002495.

32. 2018 Physical Activity Guidelines Advisory Committee. 2018 Physical Activity Guidelines Advisory Committee Scientific Report. Washington, DC: U.S. Department of Health and Human Services, 2018. https://health.gov/our-work/physical-activity/current-guidelines/scientific-report (Jun 18, 2021).

33. Chulkov VS, Lenets EA, Chulkov VlS, et al. Gender characteristics of the pathogenesis, prevention and treatment of metabolic syndrome. Arterial Hypertension. 2020;26(4):371- 82. (In Russ.). doi:10.18705/1607-419X-2020-26-4-371-382.

34. Shlyakhto EV, Zvartau NE, Villevalde SV, et al. Cardiovascular risk management system: prerequisites for developing, organization principles, target groups. Russian Journal of Cardiology. 2019;(11):69-82. (In Russ.). Шляхто Е.В., Звартау Н.Э., Виллевальде С.В. и др. Система управления сердечно-сосудистыми рисками: предпосылки к созданию, принципы организации, таргетные группы. Российский кардиологический журнал. 2019;(11):69-82. doi:10.15829/1560-4071-2019-11-69-82.

35. Rippe JM. Lifestyle Strategies for Risk Factor Reduction, Prevention, and Treatment of Cardiovascular Disease. Am J Lifestyle Med. 2018;13(2):204-12. doi:10.1177/1559827618812395.

36. Frost H, Campbell P, Maxwell M, et al. Effectiveness of Motivational Interviewing on adult behaviour change in health and social care settings: A systematic review of reviews. PLoS ONE. 2018;13(10):e0204890. doi:10.1371/journal.pone.0204890.

37. Barua RS, Rigotti NA, Benowitz NL, et al. 2018 ACC expert consensus decision pathway on tobacco cessation treatment: a report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol. 2018;72(25):3332-65. doi:10.1007/s40292-018-0278-8.

38. Krist AH, Davidson KW, Mangione CM, et al. Behavioral Counseling Interventions to Promote a Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults With Cardiovascular Risk Factors: US Preventive Services Task Force Recommendation Statement. JAMA. 2020;324(20):2069-75. doi:10.1001/jama.2020.21749.

39. Cleven L, Krell-Roesch J, Nigg CR, et al. The association between physical activity with incident obesity, coronary heart disease, diabetes and hypertension in adults: a systematic review of longitudinal studies published after 2012. BMC Public Health. 2020;20:726. doi:10.1186/s12889-020-08715-4.

40. Babb S, Malarcher A, Schauer G, et al. Quitting Smoking Among Adults — United States, 2000-2015. MMWR Morb Mortal Wkly Rep. 2017;65:1457-64. doi:10.15585/mmwr.mm6552a1.

41. Passport of the priority project “Formation of a healthy lifestyle” (approved by the Presidium of the Council under the President of the Russian Federation for Strategic Development and priority projects (protocol No. 8 of July 26, 2017)). (In Russ.) URL: http://base.garant.ru/71748614/#ixzz6z1tGXIgH (18 июня 2021).

42. Larina VN, Mkrtychev DS, Kuznetsova VA, et al. Possible Approaches to Primary Prevention of Cardiovascular Diseases. Rational Pharmacotherapy in Cardiology. 2020;16(5):831-41. (In Russ.). doi:10.20996/1819-6446-2020-10-12.