12 Aug 2017

Here are some of the latest findings (2024‑2025) in research on heart disease + lifestyle medicine. These cover diet, physical activity, risk factor modification, behaviour change, and technology. If you like, I can also pull up results specific to Malaysia or SE Asia.

Key Recent Studies & Insights

  1. Healthy Plant‑Based Diets & Mortality in Cardiometabolic Disorders
    A large multi‑cohort study (UK, US, China) with nearly 78,000 people with cardiometabolic disorders showed that closer adherence to a healthful plant‑based diet (i.e. more vegetables, fruits, whole grains, legumes, tea/coffee; less refined grains, sugary drinks, and animal‑based foods) was associated with 17‑24% lower risk of death from all causes, cardiovascular disease, or cancer. Meanwhile, diets poorer in plant‑based quality (and higher in unhealthy plant or animal foods) were linked with increased risk (28‑36%). (https://www.acc.org/About-ACC/Press-Releases/2025/03/17/15/35/Healthy-Plant-Based-Foods-Could-Help-People)

  2. Lifestyle Changes & Cardiovascular Disease Risk in Women with History of Gestational Diabetes
    A study by NUS (Singapore) + Harvard looked at women with prior gestational diabetes mellitus (GDM). Sustained healthy lifestyle habits (diet, physical activity, weight control, etc.) were found to reduce their future cardiovascular disease (CVD) risk by nearly 90%. That’s huge: shows that early intervention after GDM is very powerful. (https://medicine.nus.edu.sg/news/lifestyle-changes-can-cut-cardiovascular-disease-risk-by-nearly-90-in-women-with-gestational-diabetes-history)

  3. RCT: Mediterranean‑Inspired Diet + Physical Exercise in High‑Risk but Non‑Cardiac Individuals
    In people ≥50 yrs old at high CVD risk (but without prior heart attacks), a RCT of 12 weeks compared groups: no intervention; exercise only; and exercise + Mediterranean‑type diet. The combined diet & exercise group had better improvements in risk factors (like cholesterol, blood pressure, anthropometrics) than the others. (Barbosa AR, Pais S, Marreiros A, Correia M. Impact of a Mediterranean-Inspired Diet on Cardiovascular Disease Risk Factors: A Randomized Clinical Trial. Nutrients. 2024 Jul 26;16(15):2443. doi: 10.3390/nu16152443. PMID: 39125324; PMCID: PMC11314620.)

  4. Comprehensive Lifestyle Intervention in Patients with Established CVD
    In patients who already have cardiovascular disease and at least one lifestyle risk factor, a specialized outpatient clinic delivering a comprehensive lifestyle intervention (diet, activity, fitness, etc.) + usual care was compared to usual care alone. Results: significant improvements in physical activity/fitness, BMI, waist circumference. However, some “harder” risk factors (lipids, blood pressure) were already well controlled at baseline, so additional improvement was smaller in those. Still confirms that even when drugs are doing a lot, lifestyle helps. (Ijzelenberg, W., Hellemans, I. M., van Tulder, M. W., Heymans, M. W., Rauwerda, J. A., van Rossum, A. C., & Seidell, J. C. (2012). The effect of a comprehensive lifestyle intervention on cardiovascular risk factors in pharmacologically treated patients with stable cardiovascular disease compared to usual care: a randomised controlled trial. http://www.biomedcentral.com/1471-2261/12/71)

  5. Lifestyle, Diet Quality & Smoking: Joint Effects
    From Tehran Lipid & Glucose Study: among smokers (current/former), having a high quality diet strongly modified risk. Current smokers with a good diet had much lower risk of CVD incidence & mortality than current smokers with poor diet. Former smokers with good diet fared even better. The point: not just “stop smoking,” but combining that with good diet quality has multiplicative benefit. (Norouzzadeh, M., Teymoori, F., Farhadnejad, H. et al. Cigarette smoking and cardiovascular disease incidence and all-cause mortality: the modifying role of diet quality. BMC Public Health 24, 1021 (2024). https://doi.org/10.1186/s12889-024-18468-z)

  6. Multiple Healthy Habits After Coronary Events (Secondary Prevention)
    The REasons for Geographic and Racial Differences in Stroke (REGARDS) study looked at people with existing coronary heart disease. Adherence to several ideal lifestyle factors (non‑smoking, physical activity ≥4 times/week, Mediterranean diet, etc.) was associated with lower risk of recurrent heart disease and mortality. The more healthy behaviours maintained, the lower the risk. (Booth JN 3rd, Levitan EB, Brown TM, Farkouh ME, Safford MM, Muntner P. Effect of sustaining lifestyle modifications (nonsmoking, weight reduction, physical activity, and mediterranean diet) after healing of myocardial infarction, percutaneous intervention, or coronary bypass (from the REasons for Geographic and Racial Differences in Stroke Study). Am J Cardiol. 2014 Jun 15;113(12):1933-40. doi: 10.1016/j.amjcard.2014.03.033. Epub 2014 Apr 1. PMID: 24793668; PMCID: PMC4348576.)

  7. Older Adults & Combined Healthy Behaviors
    In older adults (≥60 yrs), a cross‑sectional study in Saudi Arabia showed that diet quality, physical activity, and not smoking were strongly associated with lower cardiovascular risk (composite score based on LDL, systolic blood pressure, BMI). Non‑smoking had the strongest direct effect; diet & activity had both direct and mediated effects. Combined behaviours produced the greatest benefit. (Almutairi, M., Almutairi, A. A., & Alodhialah, A. M. (2025). The Influence of Lifestyle Modifications on Cardiovascular Outcomes in Older Adults: Findings from a Cross-Sectional Study. Life, 15(1), 87. https://doi.org/10.3390/life15010087.)

  8. AF Risk Pathways & Biomarkers with Lifestyle Intervention
    From the PREDIMED‑Plus trial (Spain), among people with metabolic syndrome, an intensive lifestyle intervention (diet + weight loss + more physical activity) was shown to affect circulating biomarkers associated with atrial fibrillation‑related pathways. So it’s not just symptoms or clinical events but molecular / biomarker changes supporting preventive mechanisms. (Li, L., Alonso, A., Romaguera, D., Alonso-Gómez, A. M., Razquin, C., Tojal-Sierra, L., Fiol, M., Martínez-González, M. A., Subramanya, V., Salas-Salvadó, J., Fito, M., & Toledo, E. (2024). Effect of an Intensive Lifestyle Intervention on Circulating Biomarkers of Atrial Fibrillation-Related Pathways among Adults with Metabolic Syndrome: Results from a Randomized Trial. Journal of Clinical Medicine, 13(7), 2132. https://doi.org/10.3390/jcm13072132)

  9. Forecasts of Modifiable Risk Factors to 2050
    A projection based on Global Burden of Disease data forecasts that among modifiable risk factors for CVD, high systolic blood pressure will continue to be the leading contributor to DALYs (disability adjusted life years), followed by high LDL, high BMI, tobacco use, and high fasting glucose. This implies that efforts to address hypertension will remain vital. (Chong B, Jayabaskaran J, Jauhari SM, Chia J, le Roux CW, Mehta A, Dimitriadis GK, Chen Y, Toh SA, Manla Y, Al Mahmeed W, Chan SP, Goh R, Nagarajan S, Li H, Kong G, Chin YH, Wang JW, Chew HSJ, Kontopantelis E, Muthiah M, Tan JWC, Hausenloy D, Figtree GA, Mamas MA, Richards AM, Nicholls SJ, Chan MY, Lip GYH, Roth G, Mensah GA, Sperling LS, Chew NWS. The Global Syndemic of Modifiable Cardiovascular Risk Factors Projected From 2025 to 2050. J Am Coll Cardiol. 2025 Jul 22;86(3):165-177. doi: 10.1016/j.jacc.2025.04.061. PMID: 40669954.)

Emerging Themes & Practical Implications

From these studies certain patterns and implications become clear:

  • Multi‑component interventions are most effective. Combining diet, exercise, smoking cessation yields more benefit than any single one alone.

  • Early intervention matters, especially for high‑risk groups (e.g., women after gestational diabetes, metabolic syndrome). The earlier, the better.

  • Diet quality counts beyond just quantity. It’s not just “eat less” but what you eat: whole grains, vegetables, legumes, minimally processed foods vs refined grains, sugary drinks.

  • Physical activity it’s not always about duration — even modest increases, or combining physical activity + diet, yield measurable improvements.

  • Behaviour maintenance & adherence are big challenges. Lifestyle changes need to be sustained over time to deliver large risk reductions. Many studies show diminishing returns if adherence is poor.

  • Biomarkers/inflammation pathophysiology are increasingly measured; they’re helping to understand mechanisms and identify people who might benefit most from lifestyle therapy.

  • Personalization & risk stratification: understanding which individuals benefit most from which intervention (e.g. higher risk, certain biomarkers, existing disease) helps to maximize benefit.

  • Global & projection data show that unless we scale up preventive interventions (population‑wide) for hypertension, dyslipidemia, obesity, etc., the burden will continue rising.

Gaps & Future Directions

  • Long‑term trials of lifestyle change (5‑10+ years) are fewer, especially in diverse populations. We need more evidence on sustainability and long term clinical outcomes (not just risk factor / biomarker improvements).

  • More data from low‑ and middle‑income countries, and among underrepresented ethnic groups, to ensure generalizability.

  • More integration of digital/technology tools (wearables, telemonitoring, AI) for behaviour change, early detection, and personalized guidance.

  • Understanding how social determinants (health literacy, socioeconomic status, access to healthy foods, built environment) affect ability to adhere to lifestyle medicine.

  • Research into specific dietary patterns beyond Mediterranean or plant‑based, such as traditional diets in various regions, low‑carb / intermittent fasting etc., and their long‑term safety and effects.

  • More studies on psychological / stress / sleep interventions, mental health as part of cardiovascular prevention.

Dr Ruzaidi

 

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