For patients at risk of developing atherosclerosis, lifestyle modifications are crucial and should be advised and supported in line with general behaviour change approaches NICE NG238.
- Dietary Changes:
Patients should be advised to follow a cardioprotective diet, aiming for total fat intake to be 30% or less of total energy intake, with saturated fats making up 7% or less NICE NG238. Where possible, saturated fats should be replaced by mono-unsaturated and polyunsaturated fats NICE NG238. Specifically, increasing mono-unsaturated fat intake with olive oil, rapeseed oil, or spreads based on these oils is recommended for food preparation NICE NG238. A Mediterranean-style diet, which includes more bread, fruit, vegetables, and fish, less meat, and replacing butter and cheese with plant oil-based products, is also advised NICE NG185. Dietary advice should be tailored to the individual's circumstances, including any drug treatments or comorbidities NICE NG238,NICE NG185. It is important not to routinely recommend eating oily fish solely for preventing another myocardial infarction (MI), nor to offer or advise the use of omega-3 fatty acid capsules or supplemented foods for prevention NICE NG185. Additionally, patients should not take supplements containing beta-carotene, antioxidant supplements (vitamin E and/or C), or folic acid to reduce cardiovascular risk NICE NG185. An individual consultation should be offered to discuss current eating habits and provide consistent, tailored advice that can be extended to the whole family NICE NG185.
- Physical Activity:
Patients should be advised to engage in aerobic and muscle-strengthening activities according to the UK Chief Medical Officers' physical activity guidelines NICE NG238. For those who have had an MI, the advice is to undertake regular physical activity sufficient to increase exercise capacity, aiming for 20 to 30 minutes a day to the point of slight breathlessness NICE NG185. Patients who are not currently active at this level should increase their activity gradually, starting at a comfortable level and increasing duration and intensity as fitness improves NICE NG185. For individuals unable to perform moderate intensity physical activity due to comorbidity, medical conditions, or personal circumstances, they should be encouraged to exercise at their maximum safe capacity NICE NG238. Advice on physical activity should always consider the person's needs, preferences, and circumstances NICE NG238,NICE NG185.
- Smoking Cessation:
Assessing a patient's readiness to make changes to their lifestyle, including smoking, is a key component of reducing cardiovascular disease risk NICE NG238.
- Alcohol Consumption:
For advice on alcohol consumption, patients should be referred to the UK government drinking guidelines NICE NG185.
- Communication and Support:
Adequate time should be set aside during consultations to provide information on risk assessment and answer questions, with further consultations arranged if needed NICE NG238. It is important to explore the patient's beliefs about their health and assess their readiness and confidence to make lifestyle changes NICE NG238. Involving the patient in developing a shared management plan and ensuring they understand the discussions are crucial steps NICE NG238.