Overview of modifiable lifestyle risk factors for atherosclerotic cardiovascular disease

The majority of patients who develop atherosclerotic cardiovascular disease (ASCVD) have identifiable risk factors for ASCVD (see Risk factors for ASCVD and their application in the Aus CVD risk calculator). Many of these risk factors are related to lifestyle (eg smoking, nutrition); modification of these risk factors (with drug or lifestyle interventions) improves both primary and secondary cardiovascular outcomes on a population and individual level.

A healthy lifestyle should be strongly recommended to everyone; however, the benefit is greatest in people with established ASCVD or an increased risk of ASCVD; see Atherosclerotic cardiovascular disease risk estimation for information on how to determine absolute ASCVD risk.

Lifestyle modifications that are beneficial in both primary and secondary prevention of ASCVD include:

• stopping smoking
• adopting a healthy diet
• minimising the consumption of alcohol and salt
• undertaking regular physical activity
• maintaining a healthy weight.

Reduction of ASCVD risk may also require drug therapy and specific lifestyle interventions for lipid modification, blood pressure reduction and glycaemic management for patients with diabetes. Patients with established ASCVD usually also receive antiplatelet therapy; for more information about managing patients with established ASCVD, see Secondary prevention of atherosclerotic cardiovascular events.

Other modifiable risk factors for ASCVD include:

• obstructive sleep apnoea
• other sleep disorders (eg insomnia, sleep–wake disturbances in shift workers)
• social disadvantage
• shift work
• psychiatric disorders (eg depression, anxiety, schizophrenia)
• drugs known to affect blood pressure, lipids, weight or other ASCVD risk factors.

While each of these other risk factors should be managed, addressing these risk factors has not been shown to specifically improve ASCVD outcomes.