In the past few decades, due to increased efforts to control hypercholesterolemia and hypertension, cardiovascular deaths in the United States have shown a downward trend; however, the incidence of diabetes has continued to increase during this period, mainly due to the prevalence of obesity. A change is likely to increase cardiovascular mortality and even increase the incidence of cardiovascular disease in the future. The reason may be that in the prevention and treatment of cardiovascular diseases, only the downstream risk factors of dyslipidemia, hypertension, and diabetes are paid attention to, while the lifestyle risk factors such as poor eating habits and lack of physical activity are ignored.
Lifestyle has a huge impact on the risk of cardiovascular events. The specifics are as follows:
quitting smoking and reducing smoking can reduce the risk of cardiovascular events, and quitting smoking can reduce the risk of death by about 1/3. Currently, more relevant research and anti-smoking laws are needed to promote smoking cessation and increase smoking cessation rates.
Physical activity Physical activity can increase HDL-C (high-density lipoprotein, commonly known as "good cholesterol") levels, lower LDL-C (low-density lipoprotein, commonly known as "bad cholesterol") and triglyceride levels, lower blood pressure, and increase Fasting and post-meal blood sugar-insulin balance, weight loss, improve mental health, improve inflammation and endothelial function, and help quit smoking. It is precisely because of these benefits that physical activity can reduce the risk of cardiovascular events by 30% to 50%. For patients with existing cardiovascular disease, physical activity can reduce the symptoms of angina, improve heart failure, and reduce the mortality rate after myocardial infarction.
Prospective studies on eating habits have shown that low-fat diet, consumption of grains and legumes, fruits, and vegetables can continuously and significantly reduce cardiovascular risk. Other diets that can reduce cardiovascular risk include eating a small amount of nuts, drinking a small amount of alcohol, eating plant fatty acids, unsaturated fatty acids, etc. A randomized controlled study conducted in high-risk populations showed that consuming fish oil 1 to 2 times a week can reduce the risk of death from coronary heart disease by 36% and reduce the overall risk of death by 17%.
Changes in a single factor in the lifestyle can affect the risk of cardiovascular disease, while changes in multiple lifestyles at the same time play a synergistic effect. A secondary prevention study showed that a 4-year Mediterranean diet (vegetables, fruits, fish, chicken, cereals, and vegetable oils) can reduce the risk of myocardial infarction or cardiac death by 72%. Another study showed that a low-calorie diet and 20 minutes of brisk walking a day can significantly reduce the risk of new-onset diabetes by 58% compared with placebo and 39% compared with metformin. The benefits of lifestyle improvement in reducing new-onset diabetes indicate that the role of a healthy lifestyle is not only to lower blood sugar, but more importantly, to improve diabetes-related risk factors.
In the past 20 years, people’s eating habits have undergone great changes, including an increase in total food intake, an increase in high-calorie diets, and an increase in sweets. At the same time, overweight and obesity have also increased significantly. This trend once again reminds us that lifestyles can be changed, and we should identify the factors that lead to lifestyle changes and find ways to reverse them.
At present, medical policies, medical research, and clinical practice are not balanced in the strength of various medical measures. For example, the focus on the gap between guidelines and practice is usually on the control level of blood pressure, blood lipids and blood sugar, and little attention is paid to physical activity, weight or Eating habits; patients often discuss blood pressure and cholesterol levels with their doctors, but rarely discuss smoking, exercise, and eating habits. At present, clinical practice must correct this imbalance. Lifestyle should be the focus of cardiovascular disease prevention and treatment, so that diet, physical activity, and smoking assessment, follow-up, and treatment become routine. The public, patients, doctors, researchers, and medical policies The makers should reach a consensus and construct a cardiovascular disease prevention and treatment strategy based on the intervention of lifestyle risk factors.
