Perspective:

The following are 10 points to remember about this American Heart Association (AHA)/American College of Cardiology (ACC) Guideline on Lifestyle Management to Reduce Cardiovascular Risk:

1. The 2013 ACC/AHA Expert Work Group’s intent was to evaluate evidence that particular dietary patterns, nutrient intake, and levels and types of physical activity can play a major role in cardiovascular disease (CVD) prevention and treatment through effects on modifiable CVD risk factors. The evidence statements and recommendations are presented by critical questions and grouped by topic. Three primary critical questions were addressed:

1. Among adults, what is the effect of dietary patterns and/or macronutrient composition on CVD risk factors, when compared to no treatment or to other types of interventions?
   
   
2. Among adults, what is the effect of dietary intake of sodium and potassium on CVD risk factors and outcomes, when compared to no treatment or to other types of interventions?
   
   
3. Among adults, what is the effect of physical activity on blood pressure and lipids when compared to no treatment, or to other types of interventions?
   

2. Dietary recommendations to lower low-density lipoprotein cholesterol (LDL-C) include consumption of a diet high in vegetables, fruits, and whole grains. Dairy products should be low-fat. Fish, legumes, and poultry are recommended sources of protein. Vegetable oils and nuts provide healthy type oils. Limitation of sugar-sweetened beverages and red meats is recommended. There is insufficient evidence to determine whether low-glycemic diets versus high-glycemic diets affect lipids or blood pressure for adults without diabetes mellitus. The evidence for this relationship in adults with diabetes mellitus was not reviewed.

3. Additional recommendations to lower LDL-C include a dietary pattern that achieves 5-6% of calories from saturated fat. Reduction in trans-fat was also recommended.

4. This dietary pattern should be adapted for the appropriate calorie requirements, personal and cultural food preferences, and nutrition therapy for other medical conditions. This dietary pattern can be achieved by following the DASH dietary pattern, the USDA Food Pattern, or the AHA Diet.

5. Dietary recommendations to lower blood pressure are similar to those for LDL-C lowering, with added recommendations for sodium intake. Consumption of no more than 2,400 mg of sodium/day is recommended. Further reduction of sodium intake to 1,500 mg/day is associated with even greater reduction in blood pressure, and is recommended if achievable by the patients.

6. For blood pressure lowering, if recommended goals for sodium are not attainable, reducing sodium intake by at least 1,000 mg/day lowers blood pressure. A reduction in sodium intake of approximately 1,000 mg/day reduces CVD events by approximately 30%.

7. Combining the DASH dietary pattern with lower sodium intake is recommended for lowering blood pressure.

8. Recommendations to improve lipids with physical activity were also provided. These include regular aerobic physical activity, 3-4 sessions a week, lasting on average 40 minutes per session, and involving moderate- to vigorous-intensity physical activity. This level of physical activity can reduce both LDL-C and non–high-density lipoprotein cholesterol.

9. Recommendations to improve blood pressure include the same level and duration of physical activity. Again, this includes aerobic activity, 3-4 sessions a week, lasting on average 40 minutes per session, and involving moderate- to vigorous-intensity physical activity.

10. The DASH dietary pattern is beneficial for a wide range of subgroups, including women and men; African American and non–African American adults; older and younger adults; and hypertensive and nonhypertensive in lowering blood pressure. A similar pattern is observed for LDL-C lowering for African American and non–African American adults, and hypertensive and nonhypertensive adults.