Lifestyle Modification to Reduce Cardiovascular Risk

Compliance with healthy lifestyle recommendations reduced mortality and the prevalence of chronic disease in a cohort of people aged 65–98 years — the benefits of prevention apply regardless of age or number of risk factors.

Standard risk calculators such as the pooled cohort equation are not validated beyond age 79, so lifestyle advice should be given universally rather than being made conditional on a calculated risk score.

Smoking is a major cardiovascular risk factor associated with increased mortality, and cessation is beneficial even for those who quit late in life.

Smoking also increases the risk of heart failure — relative risk 1.75 in current smokers and 1.16 in former smokers — and the risk falls with years of abstinence.

A structured smoking cessation programme should be strongly recommended to every older smoker.

All movement counts. In 5,861 older women (mean age 78.5 years), the highest quartile of light physical activity was associated with a 42% reduction in myocardial infarction or coronary death.

In the Cardiovascular Health Study (4,207 subjects, mean age 72.5), greater physical activity was inversely associated with IHD, stroke, and total cardiovascular disease even in those aged ≥75.

Walking pace and walking distance were each independently associated with lower risk — important because walking is the commonest form of activity in older people.

In a Finnish study of 2,456 people aged 65–74, leisure-time physical activity reduced total and cardiovascular mortality in a dose-dependent manner, independent of baseline risk factors.

In 2,153 older men (mean age 75), mortality risk was 48% lower in the most fit compared with the least fit individuals.

Three months of exercise-based lifestyle intervention lowers blood pressure by approximately 5 mmHg systolic and 3 mmHg diastolic in older individuals.

Exercise prescription should include aerobic, resistance, balance, and flexibility components — resistance training is essential to counter sarcopenia.

Meta-analyses of observational studies show an overall protective effect of the Mediterranean diet on cardiovascular disease.

Supplementing the Mediterranean diet with extra-virgin olive oil or nuts produced a 30% reduction in major cardiovascular events in people aged 55–80 (PREDIMED).

Higher circulating omega-3 polyunsaturated fatty acids from seafood were associated with a lower risk of unhealthy ageing — dietary fish intake in older people should be increased.

The Mediterranean diet is preferred over a conventional low-fat, high-carbohydrate diet, because low-fat diets lower HDL-C as much as LDL-C.

Low sodium intake (<2 g/day) reduces systolic BP by 3.47 mmHg and diastolic BP by 1.81 mmHg. High sodium intake is associated with increased risk of stroke (RR 1.24), stroke mortality (1.63), and coronary heart disease mortality (1.32).

Maintenance of ideal body weight helps reduce BP, but restrictive diets that impair quality of life are inappropriate in older people — elevated weight short of frank obesity is associated with longer life than being underweight.

Low alcohol consumption is advised; heavy drinking causes alcoholic cardiomyopathy and heart failure.

Sodium restriction to about 1500 mg/day is prudent in heart failure, mainly for blood pressure control.

Cardiac rehabilitation — a structured, supervised lifestyle programme — improves survival in older coronary patients and reduces depression.

In older people a sedentary lifestyle showed the strongest association with incident heart failure, while the associations of smoking and hypertension attenuated with age.