Lifestyle Modifications to Prevent and Manage Coronary Artery Disease

Evidence-based data support an all-inclusive approach in managing coronary artery disease, including healthy diet, regular physical activity, mental well-being, and control of substance use.

Dietary Recommendations

The Mediterranean diet, rich in vegetables, fruits, beans, nuts, whole grains, and lean meats, significantly reduces cardiovascular events. Consuming healthy, nutritious food helps with lowering bad cholesterol, normalizing blood sugar levels, protecting cells from damage, reducing inflammation and preventing blood clot formation in the blood vessels. Researchers have also recommended limiting saturated fat intake to less than 6% of total calories and avoiding refined carbohydrates and sugary beverages and replacing them with healthy substitutes such as monounsaturated and polyunsaturated fats, complex carbohydrates, and dietary fiber. Minimizing sodium intake—ideally to 1500 mg per day—and the consumption of processed meat, along with avoiding trans fats entirely, reduces the risk of heart-related conditions. Following these dietary habits together plays a vital role in improving heart health and reducing overall complications.

Physical Activity

Patients with chronic coronary disease (CCD) should engage in at least 150 minutes of moderate-intensity aerobic activity per week. Even lower-intensity lifestyle activities, such as walking breaks, are encouraged to reduce sedentary behaviour. Performing resistance training a minimum of two times per week improves muscle strength and functional capacity. The ENRICHD trial found that regular exercise is linked to fewer recurrent cardiac events. While exercise helps maintain good blood circulation in men, it doesn’t always improve blood vessel function in postmenopausal women. However, oestrogen therapy, when combined with exercise, can restore heart health in these women. Cardiac rehabilitation (CR) programmes—comprising exercise training, nutritional counselling, emotional and behavioral support, and personalized patient assessment and medication optimisation—result in improved quality of life, reduced hospital readmissions, and lower the risk of death from heart diseases and other conditions associated with it.

Substance use

Smoking damages the blood vessel lining, thereby leading to impaired blood supply and heart function due to plaque formation — even one cigarette per day increases the chances of developing coronary heart disease and stroke. Limiting alcohol intake (to one drink per day for women and two for men) is also necessary in preventing and managing chronic heart disease. Researchers recommend considering e-cigarettes for smoking cessation but advise caution against their use due to the risk of long-term dependence and an unknown safety profile. However, another clinical study showed that both traditional and electronic cigarette smokers experience similar negative effects on their vascular function. Moreover, some studies have also concluded that e-cigarettes should not be considered safe for the heart and blood vessels. Standard guidelines recommend that doctors should assess tobacco use at every visit. They should provide counselling about the harmful effects of tobacco and support patients in quitting. This includes offering behvioral support and prescribing medications such as bupropion, varenicline, or nicotine replacement therapy.

Weight management

Obesity not only increases the risk of coronary artery disease through high blood pressure and raised lipid parameters but also directly contributes via inflammation, insulin resistance, and lipotoxicity. Lifestyle modifications, including dietary changes and increased physical activity, are the key elements in managing weight. For weight reduction, drug therapy may be considered for individuals who haven't achieved their weight-loss goals with lifestyle interventions alone.

Environmental Exposures

Reducing exposure to ambient air pollution and climate-related exposures (extreme temperatures, wildfire smoke) may also decrease the occurrence of heart problems.

Limitations and knowledge gaps

Current guidelines highlight that nonprescription nutritional supplements lack sufficient evidence to support their effectiveness in reducing acute cardiovascular events. Additionally, the impact of antidepressants on long-term cardiovascular outcomes in patients with depression remains unclear, and hence they should be used with careful consideration. Although psychotherapies like cognitive behavioural therapy (CBT) and interpersonal therapy (IPT) effectively manage depression, their benefits typically last less than six months in patients with coronary artery disease (CAD). Furthermore, these therapies do not appear to reduce the risk of adverse cardiovascular events. These areas need further research for the confirmation of efficacy and safety.

References

1. Virani, S. S., Newby, L. K., Arnold, S. V., Bittner, V., Brewer, L. C., et al. (2023). 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation, 148(9), e9–e119. https://doi.org/10.1161/CIR.0000000000001168

2. Akosile, W., Tiyatiye, B., Colquhoun, D., & Young, R. (2023). Management of depression in patients with coronary artery disease: A systematic review. Asian Journal of Psychiatry, 83, 103534. https://doi.org/10.1016/j.ajp.2023.103534

3. Syed, A. A., Adam, S., Miller, C. A., & Alkhaffaf, B. (2025). Obesity management for patients with coronary artery disease and heart failure. Heart Failure Clinics, 21(2), 257–271. https://doi.org/10.1016/j.hfc.2024.12.006

4. Medina-Leyte, D. J., Zepeda-García, O., Domínguez-Pérez, M., González-Garrido, A., Villarreal-Molina, T., & Jacobo-Albavera, L. (2021). Endothelial dysfunction, inflammation and coronary artery disease: Potential biomarkers and promising therapeutical approaches. International Journal of Molecular Sciences, 22(8), 3850. https://doi.org/10.3390/ijms22083850

5. Rao, S. V., O’Donoghue, M. L., Ruel, M., Rab, T., Tamis-Holland, J. E., et al. (2025). 2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline for the management of patients with acute coronary syndromes: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 151(13), e771–e862. https://doi.org/10.1161/CIR.0000000000001309

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