Coronary Heart Disease Prevention

Lifestyle modifications


  • Adopt a Mediterranean diet or similar heart friendly diet (1)
  • Saturated fats: < 10% of daily calorie intake. Replace saturated fats with unsaturated fats and/or unrefined carbohydrates (1)
  • Salt: < 5g/day. Reduced salt intake reduces blood pressure and risk of cardiovascular disease (1)
  • Adopt a more plant based diet rich in fibre, that includes fruits, vegetables, nuts, legumes, and whole grains (1)
  • Fruits: > 200g/day
  • Vegetables: > 200g/day
  • Fibre: 30-45g/day, preferrably from whole grain
  • Nuts: 30g/day (unsalted)
  • Keep alcohol intake below 100g per week (1)
  • Fatty fish at least one time a week (1)
  • Reduce intake of (processed) meat to below 500g/week (1)
  • Sugar: Keep intake below 10% of daily calorie intake (1)


  • For all age groups: 150-300 min a week of moderate intensity (eg. brisk walking), or 75-150 min a week of vigorous intensity (eg. jogging, running) aerobic physical activity (1)
  • When 150 min a week can not be achieved the person should strive to be as active as possible. Physical activity accumulated in bouts of 10 min or less has favorable outcomes (1)
  • Reduce sedentary time (1)
  • Perform resistance training 2 times a week to reduce risk of cardiovascular events and all cause mortality (1)


  • Smoking is a strong and independent risk factor for atherosclerotic cardiovascular disease (1)
  • Smoking cessation reduces the risk of cardiovascular disease and also improves mental health (1)


  • Patients with mental disorders need more support in order to make lifestyle changes (1)


  • If significant stress, stress reduction may improve cardiovascular disease outcomes (1)


1) 2021 ESC Guidelines:



Figure: Evidence pyramid

Evidence based on guidelines and evidence based Clinical Decision Systems is written in BOLD font

Evidence based on meta analysis or systematic reviews is written in BOLD and CURSIVE font

​Evidence based on randomized controlled trials is written in PLAIN font

Evidence based on observational / cohort studies is written in CURSIVE font