Cited by 456Cardiovascular Health and Risk FactorsHealth Promotion and Cardiovascular PreventionDiabetes, Cardiovascular Risks, and Lipoproteins

The DOI matches its Crossref record; 116 of the 124 references it cites were found in a registry or an index; none of the 43 sources its claims cite is checked for support yet.

Beyond Established and Novel Risk Factors: Lifestyle Risk Factors for Cardiovascular Disease

Abstract

D yslipidemia, hypertension, and diabetes mellitus have been appropriately highlighted as established predictors of cardiovascular disease.These risk factors have become preeminent targets for influencing cardiovascular risk; their assessment, treatment, and monitoring are major emphases of clinical care, research investigation, treatment guidelines, organization position papers, and measures of physician and hospital performance.Notably, lifestyle risk factors, including dietary habits, physical inactivity, smoking, and adiposity, strongly influence the established cardiovascular risk factors and also affect novel pathways of risk such as inflammation/oxidative stress, endothelial function, thrombosis/coagulation, and arrhythmia.Furthermore, modest alterations of these lifestyle risk factors are achievable and have substantial effects on cardiovascular risk.Thus, basic lifestyle habits should be considered fundamental risk factors for cardiovascular disease.Although efforts to combat established and novel risk factors with pharmacological treatments are important and should continue, we call for a systematic rebalancing of current research, clinical care, and policy efforts to focus more on lifestyle.The rising costs of healthcare and the epidemics of overweight and obesity highlight the inadequacies of our current strategy.Substantially more resources should be directed toward research on lifestyle risk factors, their determinants, and effective interventions to change them.The clinical evaluation and treatment of dietary, physical activity, and smoking habits must become as routine and familiar as assessment of blood pressure, cholesterol, and glucose levels.Major policy initiatives and reimbursement guidelines must also be rebalanced to emphasize lifestyle risk factors.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review argues that lifestyle risk factors—diet, physical inactivity, smoking, and adiposity—are fundamental causes of cardiovascular disease and should be prioritized alongside established and novel risk factors. It calls for rebalancing research, clinical care, and policy toward lifestyle assessment and intervention.

Key findings

  • Lifestyle factors account for most cardiovascular and diabetes burden: >70% of total cardiovascular events, 80% of CHD events, and 90% of new diabetes cases are attributable to a handful of basic lifestyle factors.
  • Modest lifestyle changes have large effects: smoking cessation reduces total mortality by approximately one third; physical activity/fitness is associated with 30% to 50% lower cardiovascular event risk; oily fish (1–2 servings/week) reduces CHD death by 36% and total mortality by 17%; a Mediterranean-type diet reduced myocardial infarction or cardiac death by 72% over 4 years; lifestyle intervention reduced diabetes incidence by 58% versus placebo and 39% versus metformin.
  • Population behavior can change: US per capita tobacco use fell nearly two thirds since the 1950s; from 1977 to 2000, average fat consumption declined from 36.4% to 32.8% of calories and carbohydrate increased from 44.3% to 50.3%, while total calories rose from 2000 to 2250 kcal/d.
  • Adherence is imperfect for both lifestyle and drugs: in the Women’s Health Initiative, 40% stopped the study drug at an average 5.2 years and 54% at 6.8 years; in the Diabetes Prevention Project, 58% maintained the physical activity goal, 38% achieved the weight loss goal, and 67% were ≥80% adherent to drug therapy; lipid-lowering or antihypertensive adherence typically ranges from 65% to 85% in trials to <50% in practice.

Methods

  • Design: narrative review/commentary, not original research; it synthesizes evidence from epidemiological studies and randomized controlled trials.
  • Data or sample: no primary sample; it cites prior studies and trials (e.g., Framingham, DPP, WHI, Lyon Diet Heart Study, Look AHEAD) and MEDLINE publication counts as of December 2007.
  • Main analysis: narrative synthesis and argument for rebalancing research, clinical care, and policy toward lifestyle risk factors.

Limitations

  • The paper states that direct evidence comparing adherence to modest lifestyle changes versus lifelong drug use is scant; additional research is needed on optimal behavior-change strategies; and the quality of evidence for some cardiovascular drugs exceeds that for some lifestyle changes because of discrepancies in the sizes and numbers of large randomized trials.
  • Evident from the text: as a narrative review, it lacks a systematic search, formal meta-analysis, risk-of-bias assessment, or primary data, and its evidence selection and emphasis reflect the authors’ perspective.

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Integrity signals

Registry

Crossref · 10.1161/circulationaha.107.738732

Cites

116 of 116 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 43 cited sources checked · 0 supported · 0 flagged

  • It may state two separate claims as one. 15
  • Probably not a substantial claim. 3
17 of 17

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Citations

Cites

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8 of the 124 references couldn’t be matched to a known paper.

Research works printed but not linked: 4

  1. 10.1161/circ.97.18.1837 · DOI
  2. 10.1161/circ.99.15.2055 · DOI
  3. 10.1161/circ.104.13.1577 · DOI
  4. 10.1161/circ.99.6.779 · DOI

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Metadata

Authors
Mozaffarian, D., Wilson, P. W. F., & Kannel, W. B.
Affiliations
Boston University (US)
Venue
Circulation
Published
2008-06-10
Volume
117
Issue
23
Pages
3031-3038
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
OpenAlex
W2080422716
Cited by
456
References
124
Citations by year
2026: 19 · 2025: 41 · 2024: 30 · 2023: 33 · 2022: 39 · 2021: 24 · 2020: 27 · 2019: 19 · 2018: 15 · 2017: 12 · 2016: 28 · 2015: 21 · 2014: 36 · 2013: 26 · 2012: 25
FWCI
3.08
Type
journal article
Language
en
Open access
closed
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (n01hc25195-41-0-1, 1k08hl075628-01)
  • National Heart, Lung, and Blood Institute (K08-HL-075628, N01‐HC25195)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
cardiovascular risk factors, lifestyle risk factors, dyslipidemia, hypertension, diabetes mellitus, physical inactivity, smoking, adiposity, inflammation, oxidative stress, endothelial function, thrombosis, cardiac arrhythmias, dietary habits, lifestyle intervention, healthcare policy, reimbursement guidelines
MeSH terms
Cardiovascular Diseases, Humans, Life Style, Risk Factors, Risk Reduction Behavior

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