Comparison of lifestyle changes and pharmacological treatment on cardiovascular risk factors
Pedro Marques‐Vidal
Abstract
### Learning objectives Chapters 2.7.1 and 2.7.2 of the ESC curriculum. Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in Europe and worldwide.1 The major modifiable risk factors (obesity, hypertension, smoking, dyslipidaemia and diabetes) are well known and guidelines regarding their management have been issued.2–6 All guidelines focus on the importance of lifestyle changes, which should be implemented before or in conjunction with drug therapy. Still, most studies show that implementation of a healthy lifestyle is far from optimal, a significant percentage of patients with CVD risk factors reporting no change at all.7 8 The effects of lifestyle changes, alone or in conjunction with medical treatment, on CVD risk factors are seldom put forward. In this paper, we will make a brief overview of the effect of lifestyle changes (smoking cessation, adopting a healthier diet and increasing physical activity (PA)) on CVD risk factors (high blood pressure (BP), dyslipidaemia and hyperglycaemia) and compare them with the effect of pharmacological treatment. As smoking cessation per se is the most powerful lifestyle determinant of CVD,9 only the effects of smoking cessation on other risk factors will be assessed. ### High BP The results of lifestyle changes and of antihypertensive drug treatments on BP levels are summarised in table 1, and comparison between lifestyle and drug effects is provided in figure 1A (for systolic blood pressure (SBP)) and figure 1B (for diastolic blood pressure (DBP)). View this table: Table 1 Effect of lifestyle and drug interventions on blood pressure levels Figure 1 Comparison between lifestyle and drug effects on systolic (A) and diastolic (B) blood pressure levels. DASH, Dietary Approach to Stop Hypertension; HT, hypertensive subjects. Weight loss …