Healthy lifestyle in secondary cardiovascular disease prevention: Dietary patterns, physical activity, and their long-term benefits

Abstract

Cardiovascular disease (CVD) is a leading global cause of morbidity and mortality, contributing to 18 million deaths annually. While unhealthy lifestyle habits are key risk factors for developing CVD, pharmacological interventions often supersede lifestyle modifications once the disease becomes clinically manifest. In this thesis, we explored the role of healthy dietary and physical activity habits in managing stable CVD. We assessed the relationship between different dietary patterns, mainly the Mediterranean and DASH diets, and cardiovascular risk factor levels. Furthermore, we explored how compliance with these dietary patterns was associated with risk of recurrence of cardiovascular events such as myocardial infarction or stroke. Concurrently, we analysed the association between different types of physical activity and clinical outcomes, elucidating the biological pathways mediating these relationships. In the final part of the thesis, we present an integrated approach to lifestyle change. The aims of this part were to predict the lifetime benefit of adopting a healthy lifestyle even after CVD has become clinically manifest. We demonstrated that multiple years free of recurrent cardiovascular events could be achieved through lifestyle interventions and that lifestyle interventions are highly cost-effective. In conclusion, this thesis provides comprehensive insights into the multifaceted role of healthy dietary and physical activity habits in the clinical management of stable CVD, emphasizing the potential for lifestyle interventions even after clinical manifestation. The findings support the integration of active lifestyle guidance into routine clinical care for patients with established CVD.