Table 5

Summary of Recommendations for Lifestyle Management

RecommendationsNHLBI GradeNHLBI Evidence StatementsACC/AHA CORACC/AHA LOE
DIET
LDL-C: Advise adults who would benefit from LDL-C lowering to:
  • 1. Consume a dietary pattern that emphasizes intake of vegetables, fruits, and whole grains; includes low-fat dairy products, poultry, fish, legumes, nontropical vegetable oils, and nuts; and limits intake of sweets, sugar-sweetened beverages, and red meats.

    • a. Adapt this dietary pattern to appropriate calorie requirements, personal and cultural food preferences, and nutrition therapy for other medical conditions (including diabetes).

    • b. Achieve this pattern by following plans such as the DASH dietary pattern, the USDA Food Pattern, or the AHA Diet.

A (Strong)CQ1: ES4 (high), ES6 (low), ES8 (moderate), ES9 (moderate)IA
  • 2. Aim for a dietary pattern that achieves 5%–6% of calories from saturated fat.

A (Strong)CQ1: ES11 (high)IA
  • 3. Reduce percent of calories from saturated fat.

A (Strong)CQ1: ES11 (high), ES12 (moderate), ES13 (moderate)IA
  • 4. Reduce percent of calories from trans fat.

A (Strong)CQ1: ES14 (moderate), ES15 (moderate)IA
BP: Advise adults who would benefit from BP lowering to:
  • 1. Consume a dietary pattern that emphasizes intake of vegetables, fruits, and whole grains; includes low-fat dairy products, poultry, fish, legumes, nontropical vegetable oils, and nuts; and limits intake of sweets, sugar-sweetened beverages, and red meats.

    • a. Adapt this dietary pattern to appropriate calorie requirements, personal and cultural food preferences, and nutrition therapy for other medical conditions (including diabetes).

    • b. Achieve this pattern by following plans such as the DASH dietary pattern, the USDA Food Pattern, or the AHA Diet.

A (Strong)CQ1: ES1 (low) ES3 (high), ES5 (high), ES6 (low), ES7 (low), ES8 (moderate)IA
  • 2. Lower sodium intake.

A (Strong)CQ2: ES1 (high), ES2 (moderate), ES3 (high), ES4 (high), ES5 (high), ES8 (low), ES9 (low)IA
    • a. Consume no more than 2,400 mg of sodium/d;

    • b. Further reduction of sodium intake to 1,500 mg/d can result in even greater reduction in BP; and

    • c. Even without achieving these goals, reducing sodium intake by at least 1,000 mg/d lowers BP.

B (Moderate)CQ2: ES2 (moderate), ES3 (high)IIaB
  • 4. Combine the DASH dietary pattern with lower sodium intake.

A (Strong)CQ1: ES3 (high), ES5 (high), ES8 (moderate)
CQ2: ES1 (high), ES2 (moderate), ES3 (high), ES4 (high), ES5 (high), ES6 (moderate)
IA
PHYSICAL ACTIVITY
Lipids
  • 1. In general, advise adults to engage in aerobic physical activity to reduce LDL-C and non–HDL-C: 3–4 sessions per wk, lasting on average 40 min per session, and involving moderate- to vigorous-intensity physical activity.

B (Moderate)CQ3: ES1 (moderate), ES2 (moderate), ES5 (low)IIaA
BP
  • 1. In general, advise adults to engage in aerobic physical activity to lower BP: 3–4 sessions per wk, lasting on average 40 min per session, and involving moderate- to vigorous-intensity physical activity.

B (Moderate)CQ3: ES1 (high)IIaA

ACC indicates American College of Cardiology; AHA, American Heart Association; BP, blood pressure; COR, Class of Recommendation; CQ, critical question; DASH, Dietary Approaches to Stop Hypertension; ES, evidence statement; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; LOE, Level of Evidence; NHLBI, National Heart, Lung, and Blood Institute; and USDA, U.S. Department of Agriculture.

  • Refer to 2013 Blood Cholesterol Guideline for guidance on who would benefit from LDL-C lowering (4).