Lifestyle Medicine, Third Edition

James M. Rippe, James M. Rippe

• Publisher: CRC Press
• Year: 2019
• ISBN:
  9781351780995
• Edition: 3
• Topic: Scienze biologiche
• Subtopic: Scienze motorie e sportive

The field of lifestyle medicine, which is the study of how daily habits and actions impact on both short- and long-term health and quality of life, continues to expand globally. The scientific and medical literature that supports the success of these lifestyle habits and actions is now overwhelming. Thousands of studies provide evidence that regular physical activity, maintenance of a health body weight, following sound nutritional practices, stress reduction, and other good practices all profoundly impact both health and quality of life.

Following its predecessors, Lifestyle Medicine, Third Edition, is edited by lifestyle medicine pioneer, cardiologist Dr. James Rippe. This edition has been thoroughly updated and represents the expert opinions of 20 section editors as well as more than 150 expert chapter authors whose knowledge span all aspects of this emerging discipline. Topics cover lifestyle medicine practices including regular physical activity, proper nutrition, and weight management. These principles are applied to the prevention and or treatment of a wide variety of chronic conditions ranging from heart disease and diabetes to cancer, mental health, addiction, and injury prevention.

This book serves as evidence base for individuals who wish to practice lifestyle medicine or incorporate some of its principles into either general medicine or subspecialty practice. It provides valuable information to healthcare workers in the fields of nutrition, exercise physiology, psychology, behavioral medicine, health promotion, and public policy where lifestyle medicine principles play an ever-increasing role.

Part
I

Lifestyle Management and Prevention of Cardiovascular Disease

James M. Rippe, MD

Chapter
1

The Rationale for Intervention to Reduce the Risk of Cardiovascular Disease

James M. Rippe, MD and Theodore J. Angelopoulos PhD, MPH

Key Points

1.1 Introduction

1.1.1 The Pathophysiology of Atherosclerosis

1.2 Understanding Risk Factors

1.2.1 The Concept of Risk Factors

1.2.2 Relative Risk versus Absolute Risk

1.2.3 Primary versus Secondary Prevention

1.3 Primordial Prevention and “Ideal” Cardiovascular Health

1.4 Implementing Risk Factor Reduction Guidelines

1.5 The Scientific Basis for Risk Factor Reduction

1.6 Evidence-Based Versus Risk-Based Strategies for Prevention of Cardiovascular Disease

1.7 Modifiable Risk Factors

1.7.1 Tobacco Use

1.7.2 Dyslipidemias

1.7.2.1 Elevated Low Density Lipoprotein Cholesterol and Hyperlipidemia

1.7.2.2 Low Levels of HDL Cholesterol

1.7.2.3 Hypertriglyceridemia

1.7.3 Hypertension

1.7.4 Diabetes and Glucose Intolerance

1.7.5 Obesity

1.7.6 Inactive Lifestyle

1.7.7 Poor Nutritional Habits

1.8 Nonmodifiable Risk Factors

1.8.1 Age

1.8.2 Gender

1.8.3 Family History

1.9 The Metabolic Syndrome and the Concept of Multiple Risk Factors

1.10 Emerging Risk Factors

1.10.1 High Sensitivity C-Reactive Protein (hs-CRP)

1.10.2 Other Markers of Inflammation

1.10.3 Hemostatic Factors

1.10.4 Homocysteine

1.10.5 LDL Subclasses and Particle Size

1.10.6 Lipoprotein (a)

1.11 Other Risk Factors

1.11.1 Levels of Antioxidants

1.11.2 Alcohol

1.11.3 Stress and Type A Personality

1.11.4 Depression

1.12 Future Trends in Risk Factor Assessment

1.12.1 Direct Plaque Imaging

1.12.2 Genomic Approaches

1.12.3 New Risk Factor Scoring Systems

1.12.4 Implementation of Risk Factor Reduction Strategies

1.13 Conclusions

Clinical Applications

References

Key Points

• Cardiovascular Disease (CVD) remains the leading cause of death and disability in the United States and worldwide.
• Multiple risk factors increase the risk of CVD. Many of these risk factors have a significant lifestyle component.
• There has been a significant decrease in CVD mortality over the past four decades. Half of this decrease is due to lower risk factors. Increases in several risk factors, however, including obesity and diabetes, threaten to wipe out gains in all other risk factors.
• If individuals used the following four positive daily lifestyle measures, the prevalence of CVD could be decreased over 80% and the prevalence of diabetes could be decreased over 90%. The measures are¹ maintain proper weight,² do not smoke cigarettes,³ engage in regular physical activity, and⁴ follow sound nutritional patterns.
• The American Heart Association (AHA) has recommended an emphasis on “primordial prevention,” which means lowering the likelihood of developing risk factors in the first place.
• Physician visits are an ideal opportunity to stress the importance of lifestyle habits and practices to reduce the risk of cardiovascular disease.

1.1 Introduction

Cardiovascular disease (CVD) remains the leading cause of death for both men and women in the United States each year.¹ Over 37% of all mortality in the United States comes from cardiovascular disease.¹ Although knowledge of many factors contributing to CVD is incomplete, it is clear that many risk factors contribute in significant ways to the ongoing epidemic of cardiovascular disease.

Cardiovascular disease is truly a pandemic and represents the most important cause of death worldwide. In 2010, cardiovascular disease resulted in an estimated 16 million deaths and 293 million disability-adjusted life years (DALYs) lost. These represent approximately 30% of all deaths worldwide and 11% of all DALYs lost that year. This disease not only impacts high-income countries but has become increasingly prevalent in both low- and middle-income countries, which have seen an alarming increase in CVD rates.

So prominent has been the role of certain lifestyle factors that it has been argued that the world is entering into a new epidemiologic transition. In the past four epidemiologic transitions, the predominant causes of death have been identified starting with pestilence and famine, then receding pandemics, followed by degenerative and man-made diseases, and finally delayed degenerative diseases. It has been argued that the modern world maybe entering a fifth epidemiologic phase highlighted by inactivity and obesity/diabetes, both of which contribute in significant ways to CVD.²

Lifestyle habits and practices constitute a significant contributor to this ongoing epidemic. While progress has been made in some of these areas (e.g., hypertension, total cholesterol, smoking cessation, physical activity), unfortunately, regression has occurred in such areas as obesity and diabetes.³ The increasing prevalence of these latter two conditions has the potential to wipe out progress made on all the other lifestyle-related risk factors for CVD.³

In addition to its human cost, CVD also represents an enormous financial drain in the United States. It has been estimated that over $150 billion per year is spent on direct medical expenses and other associated costs related to CVD.^{4, 5}

Lifestyle factors play a particularly prominent role in the development and pathogenesis of CVD. Indeed, five of the major risk factors for developing CVD relate to lifestyle practices, including the following: the choice of whether or not to use tobacco products, level of physical activity, control of lipids, diabetes, and obesity.⁶

In this chapter we focus on the rationale for intervening to reduce risk factors for CVD. The next chapter, “Lifestyle Strategies for Risk Factor Reduction, Prevention, and Treatment of Cardiovascular Disease,” will discuss applications of lifestyle interventions in clinical practice to reduce the risk of CVD.

Deaths from CVD and stroke have been declining in the United States for the past four decades. For example, between 1963 and 1990 the mortality of coronary heart disease fell by more than 50%.⁷ Nonetheless, CVD and stroke remain the leading causes of morbidity and mortality in the United States and in most other industrialized countries. The decline in CVD and stroke is a result of not only reduced prevalence of risk factors but also advances in treatment and therapies. H...