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Multiple lifestyle changes in people with established coronary heart disease reduce the risk for cardiovascular events

de Waure C, Lauret GJ, Ricciardi W, et al. Lifestyle interventions in patients with coronary heart disease: A systematic review. American Journal of Preventive Medicine. 2013. Volume 45, Issue 2, pages 207-216.

Review question

How effective are interventions with multiple lifestyle components (such as diet AND exercise) in reducing the risk for cardiovascular events in patients with established heart disease?


Heart disease is associated with a higher risk of cardiovascular events[DK1] , including myocardial infarction (heart attack), stroke, and death from heart disease. These events can be fatal (causing death) or non-fatal. Secondary prevention of heart disease involves interventions to prevent the worsening of the disease, or to prevent acute cardiovascular events, in people who already have heart disease.

Interventions generally attempt to change at least two behaviors that increase risk for heart disease, including diet, exercise, smoking and psychological factors.

How the review was done

This summary is based on a high-quality review of 14 randomized controlled trials conducted between 1979 and 2011 with 6,657 participants.

Study participants, most of whom were men, ranged in 53 to 80 years old. The average age was 60.

All of the interventions included nutritional recommendations as well as physical activity instruction. 11 studies also included smoking recommendations and half provided interventions around stress management.


The intervention group was compared with a group receiving usual care, which was defined as a treatment chosen by their doctor.


The interventions varied in length from 29 days to 6 years, but most were 2 or 3 years long. Studies followed participants for periods from 1 to 19 years following the intervention.

What the researchers found

Multi-component interventions reduce the risk of fatal cardiovascular events by 18% in patients with established heart disease when compared with usual care. These interventions had no impact on non-fatal or total cardiovascular events.


Multicomponent lifestyle interventions are effective in preventing fatal cardiovascular events in patients with established heart disease.


Coronary heart disease
Also known as coronary artery disease (CAD), is a narrowing of the blood vessels (coronary arteries) that supply oxygen and blood to the heart.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
The body's network of blood vessels. It includes the arteries, veins, and capillaries that carry blood to and from the heart.

Related Web Resources

  • Coronary artery disease risk screening

    Health Link B.C.
    Men over 40 and women past menopause or over 50 should get screened for coronary artery disease (CAD) every 1 to 3 years. Your risk is higher if you have diabetes, high blood pressure, abdominal obesity, kidney disease, family history of CAD or if you smoke.
  • High cholesterol: Does reducing the amount of fat in your diet help?

    Informed Health Online
    Eat less saturated fats in your diet to help prevent heart disease. Eat less meat, butter, cheese and cream to improve your health long-term.
  • Statins: Should I Take Them to Prevent a Heart Attack or Stroke?

    This patient decision aid helps people considering taking medicines called statins to lower their risk of heart attack and stroke by comparing the benefits, risks, and side effects of both options. It also includes alternative treatment options to taking statins such as trying to lower risk with lifestyle changes.
DISCLAIMER These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (

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