In 2013, the American Heart Association and the American College of Cardiology published a first-ever joint clinical practice guideline on lifestyle management to reduce cardiovascular disease (CVD) risks. Published simultaneously in Circulation and the Journal of the American College of Cardiology, the guideline is based on a systematic evidence review from studies published between 1990 and 2012. It summarizes key nutrition and physical activity topics for managing blood pressure (BP) and cholesterol.

Healthy Eating & Physical Activity

“To lead a lifestyle that can reduce CVD risks, heart-healthy eating habits and physical activity are paramount,” says Robert H. Eckel, MD, who co-chaired the expert writing group that developed the guidelines. To lower cholesterol, the guideline strongly recommends limiting saturated fat and trans fat. To lower BP, an emphasis is placed on restricting sodium to no more than 2,400 mg/day. Further reductions of sodium intake to no more than 1,500 mg/day are linked to an even greater reduction in BP. “Eating a heart-healthy diet is more about the overall diet rather than isolating specific foods that are eaten,” adds Dr. Eckel.


A heart-healthy diet should focus on fruits, vegetables, and whole grains and include low-fat dairy products, poultry, fish, and nuts. It should also limit red meat, sweets, and sugar-sweetened beverages. “Following this pattern should help limit the intake of saturated fat, trans fat, and sodium to the recommended levels,” Dr. Eckel says. Adaptations to heart-healthy diet plans should be considered based on each person’s caloric requirements, personal and cultural food preferences, and nutrition therapy for other health conditions, such as diabetes. The guideline also recommends moderate- to vigorous-intensity aerobic exercise, such as brisk walking, for 40 minutes three or four times per week.

Prescriptions Help

Even by adhering to recommendations for lifestyle management, some patients will still require prescription drugs to manage BP and cholesterol. “Physicians should take at least a few minutes and assess lifestyle habits in their patients, and then prescribe lifestyle management strategies just as they would prescribe a drug,” says Dr. Eckel. “Whenever medications are being prescribed, physicians should give patients a prescription for lifestyle management at the same time. It’s critical to incorporate these modifications throughout the therapeutic window.”

Dr. Eckel notes that the recommendations address important questions that should be considered by all providers caring for patients with or at risk of CVD. The positive impact of a heart-healthy lifestyle takes place over many years with behavioral interventions, he says. “As more data emerge, subsequent collaborative joint guidelines in this area are expected to help broaden our knowledge on the efficacy of these interventions.”