Lifestyle Interventions for Managing Chronic Coronary Syndromes

This article is based on the 2024 ESC Guidelines for the management of chronic coronary syndromes: Developed by the task force for the management of chronic coronary syndromes of the European Society of Cardiology (ESC) and endorsed by the European Association for Cardio-Thoracic Surgery (EACTS). It focuses on guideline-directed therapy in areas such as smoking and substance abuse, weight management, and physical activity. 

When it comes to maintaining and improving heart health, education on making proper lifestyle choices can help [2]. While interventional cardiologists provide treatment in the Cath lab, it is up to individuals to take care of themselves outside the lab. This self-care is essential for reducing the risk of cardiovascular diseases and must be a lifelong commitment. To support this, the European Society of Cardiology (ESC) offers a table titled “Practical advice on lifestyle counselling and interventions” which provides guidance on optimizing lifestyle to lower the risk of cardiovascular disease (CVD). 

Smoking and substance abuse   

It is no surprise today that smoking contributes to numerous diseases. For individuals with chronic coronary syndrome (CCS), quitting smoking reduces the risk of premature death by 36% [3]. Fortunately, various strategies are available to help individuals quit smoking, including behavioral interventions and pharmacological therapy [4][5]. 

• Effective drugs to assist smoking cessation [6][7]
  • Nicotine-replacement therapy 
  • Bupropion 
  • Varenicline   

E-cigarettes (vaping) contain toxins and should also be avoided [8]. However, vaping should only be considered with a plan to quit smoking. 

For more information on smoking cessation follow this link: CardyFit | Smoking Cessation

Weight Management  

The target Body Mass Index (BMI) for healthy weight is in the range of (18.5–24.9 kg/m²) [9]. A higher–than–normal BMI has been shown to reduce lifespan and increase the risk of cardiovascular disease (CVD). For individuals with coronary artery disease (CAD) who are overweight, weight loss showed a reduction in risk of adverse clinical outcomes [10]. Maintaining a healthy weight requires a balanced healthy diet with energy intake specific to individual needs, along with regular physical activity [11]. 

For information on weight loss follow this link: CardyFit | Obesity & Weight Loss Diet  

Diet and Alcohol 

Diet plays a crucial role when it comes to protection against CVD. A mediterranean diet, or a similar eating pattern, is recommended to reduce CVD risk [11]. The diet emphasizes foods like fruits, vegetables, seeds, nuts and fish. Alcohol consumption should be limited to less than 100 grams per week or 15 grams per day, as exceeding this amount increases the risk of all-cause mortality [12].

Mental Health 

Psychological risk factors such as stress, depression and anxiety should be addressed, as they can negatively impact cardiovascular health [11]. Clinical trials have shown that both psychological and pharmacological interventions can help reduce stress, depression and anxiety, leading to a decrease in cardiac mortality [13].  

Physical activity 

It is well known that physical activity is essential for both adults and children to maintain good health. Regular physical activity is associated with a reduction in all-cause mortality, cardiovascular mortality and atherosclerotic cardiovascular disease (ASCVD) [14].   

Physical activity recommended per week for adults [14]: 

• 150-300 min of moderate intensity
• 75-150 min of vigorous intensity physical activity 
• An equal combination of both  

For individuals unable to meet the recommended weekly physical activity guidelines, making some effort is better than none [15]. The choice of day and time for exercises can be tailored to personal preference. 

Exercise therapy 

Exercise, whether done independently or as part of a comprehensive, exercise-based cardiac rehabilitation program, helps reduce hospitalizations, adverse cardiovascular events and mortality rates in patients with ASCVD [16][17][18][19]. 

Aerobic exercises 

For aerobic activities such as swimming, walking, jogging, cycling, it’s recommended to exercise at least 3 days per week, but ideally 6-7 at a moderate to moderately high intensity [20]. Relative intensity is based on a person’s maximum (peak) effort, which can be measured as a percentage of their cardiorespiratory fitness (%VO2 max), maximum heart rate (%HRmax), or ventilatory thresholds (VT1 and VT2). 

Resistance training 

Combining resistance training with aerobic training can help lower the risk of cardiovascular events and all-cause mortality [11]. It is recommended to do three sets of 8-12 repetitions with the intensity of 6%-80% of an individual’s one rep maximum, preferably twice a week of varying exercises for the major muscle groups [21]. 

Caution for specific individuals 

While exercise is important it’s not safe for everyone. Individuals with severe or unstable angina, as well as those with serious cardiovascular conditions should not participate. Some major high-risk conditions include high-grade arrhythmias, decompensated heart failure, severe aortic dilation and active thrombo-embolic disease [22]. Additionally, for non-cardiac related issues such as active infections, uncontrolled diabetes, advanced cancer, chronic obstructive pulmonary disease exacerbation (COPD), exercise is also not recommended. In these cases, exercise could pose serious health risks. 

References