Improving dietary and lifestyle habits is a critical part of any strategy for cardiovascular risk reduction. The American Heart Association (AHA) recently revised its diet and lifestyle recommendations to reflect new evidence.

GOALS

There are seven lifestyle goals to help in the prevention of cardiovascular disease. These goals are intended for patients older than two years.

• Consume an overall healthy diet. Persons should aim to improve their diet as a whole by eating a variety of fruits, vegetables, and grains (especially whole grains) as opposed to focusing on a single nutrient or food. The AHA also recommends that persons eat legumes, poultry, lean meats, fish, and low-fat and fat-free dairy products.

• Aim for a healthy body weight. A heathy body weight is defined as a body mass index (BMI) of 18.5 to 24.9 kg per m². A BMI of 25 to 29.9 kg per m² is considered overweight, and a BMI of 30 kg per m² or higher is considered obese.

• Aim for a desirable lipid profile. An optimal low-density lipoprotein (LDL) cholesterol level is a measurement lower than 100 mg per dL (2.60 mmol per L). A measurement of 100 to 129 mg per dL (3.34 mmol per L) is near optimal; 130 to 159 mg per dL (3.36 to 4.12 mmol per L) is borderline high; 160 to 189 mg per dL (4.14 to 4.90 mmol per L) is high; and 190 mg per dL (4.92 mmol per L) or higher is very high. Saturated fats andtrans fats are the greatest dietary causes of elevated LDL cholesterol levels.

Although the AHA does not recommend specific goals for high-density lipoprotein cholesterol, levels lower than 40 mg per dL (1.04 mmol per L) for men and lower than 50 mg per dL (1.30 mmol per L) for women are criteria for metabolic syndrome. There also are no triglyceride goals, but a level higher than 150 mg per dL (1.70 mmol per L) is a criterion for metabolic syndrome.[ corrected]

• Aim for normal blood pressure. Normal blood pressure is a systolic measurement of less than 120 mm Hg and a diastolic measurement of less than 80 mm Hg. Elevated blood pressure is caused by environmental factors, genetic factors, and the interaction of these factors. The largest environmental cause is diet. Dietary modifications that lower blood pressure include reducing salt intake, creating a caloric deficit (to induce weight loss), moderating alcohol consumption in persons who consume alcohol, increasing potassium intake, and consuming an overall heathy diet.

• Aim for a normal blood glucose level. A normal fasting glucose level is 100 mg per dL (5.55 mmol per L) or less. A fasting glucose level of 126 mg per dL (7.00 mmol per L) or higher is classified as diabetes. Type 2 diabetes is the most common form of diabetes, and reduced caloric intake and increased physical activity can decrease insulin resistance and improve glucose control.

• Be physically active. Regular physical activity improves blood pressure, lipid profiles, and blood sugar levels. It also can lower the risk of developing type 2 diabetes, osteoporosis, obesity, depression, and cancers of the breast and colon.

• Avoid the use of and exposure to tobacco products.

RECOMMENDATIONS

There are nine diet and lifestyle recommendations intended to reduce cardiovascular disease risk.

• Balance caloric intake and physical activity to achieve or maintain a healthy body weight. To control caloric intake, persons should be aware of the calorie content in foods and beverages and control portion size. A physically active lifestyle is recommended for all persons, even those at a healthy weight. The AHA recommends that all adults exercise for at least 30 minutes on most days (60 minutes for adults trying to lose weight and for children).

• Consume a diet rich in vegetables and fruits. Vegetables and fruits have been proven to lower blood pressure. Deeply colored vegetables and fruits (e.g., spinach, carrots, peaches, berries) should be emphasized because of their high nutrient content.

• Choose whole-grain, high-fiber foods. Diets high in whole-grain products and fiber are associated with a decreased risk of cardiovascular disease.

• Consume fish, especially oily fish, at least twice a week. Consuming 8 oz of fish high in very long-chain omega-3 polyunsaturated fatty acids per week reduces the risk of sudden death and death from coronary artery disease. Because of possible methyl mercury contamination, children and pregnant women are advised to avoid eating shark, swordfish, king mackerel, or tilefish. For older men and postmenopausal women, the benefits of fish consumption outweigh the risks.

• Limit intake of saturated and transfat and cholesterol. The AHA recommends that persons consume less than 7 percent of calories as saturated fat and less than 1 percent astrans fat, and consume less than 300 mg of cholesterol per day. The major dietary sources of saturated fats and cholesterol are of animal origin (e.g., meat, eggs, dairy), and the major sources oftrans fats are partially hydrogenated oils used to prepare commercially fried and baked products.

• Minimize intake of beverages and foods with added sugars. Persons who consume beverages with added sugars usually consume more calories per day and gain weight.

• Choose and prepare foods with little or no salt. The AHA recommends a daily sodium intake of no more than 2.3 g. Blood pressure tends to increase with salt intake. Reduced sodium intake is associated with slowed age-related increase in blood pressure and reduced risk of atherosclerotic cardiovascular events and congestive heart failure.

• Consume alcohol in moderation, if at all. It is recommended that men consume no more than two drinks per day, and women consume no more than one. Alcoholic drinks should be consumed with meals.

• Follow the AHA 2006 diet and lifestyle recommendations when eating food that is prepared outside the home.