Integrative Strategies for Cardiovascular Risk Reduction: Synergy between Lifestyle Modifications and Pharmacotherapy
DOI:
https://doi.org/10.12775/QS.2026.53.69368Keywords
Cardiovascular disease, Dyslipidemia, Lifestyle modification, Pharmacotherapy, Physical activity, Mediterranean dietAbstract
Background: Cardiovascular diseases (CVD) remain the leading cause of mortality worldwide, primarily driven by atherosclerosis. Dyslipidemia, characterized by elevated atherogenic lipoproteins, represents a key modifiable risk factor in both primary and secondary prevention.
Objective: This narrative review synthesizes current evidence on the integrative management of dyslipidemia, emphasizing the combined role of lifestyle modifications: physical activity, dietary patterns, weight management and established and emerging pharmacological therapies.
Methods: A narrative review of European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) guidelines, as well as peer-reviewed literature, was conducted. The analysis focused on lipid metabolism, nutritional strategies, physical activity, and lipid-lowering therapies ranging from statins to novel siRNA-based agents.
Results: Lifestyle interventions are the foundation of cardiovascular prevention. Regular physical activity (150–300 min/week) and weight reduction in obesity lead to meaningful improvements in lipid profiles. Dietary modifications, particularly reducing saturated fats and improving fat quality, contribute to lowering LDL-C and triglyceride levels. In patients at high or very high cardiovascular risk, lifestyle measures alone are frequently insufficient, necessitating pharmacotherapy, primarily statins, with add-on agents such as ezetimibe, PCSK9 inhibitors, or inclisiran to achieve lipid targets.
Conclusion: A comprehensive strategy integrating sustained lifestyle modification with intensified pharmacotherapy provides the greatest reduction in CVD risk. Understanding the synergistic effects of these interventions may improve long-term adherence and overall treatment effectiveness.
References
Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41(1):111-188. https://doi.org/10.1093/eurheartj/ehz455
Visseren FLJ, Mach F, Smulders YM, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42(34):3227-3337. https://doi.org/10.1093/eurheartj/ehab484
Pahwa R, Jialal I. Atherosclerosis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2025 Jan 15]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507799/
Hoogeveen RC, Ballantyne CM. Residual Cardiovascular Risk at Low LDL: Remnants, Lipoprotein(a), and Inflammation. Clin Chem. 2021;67(1):143-153. https://doi.org/10.1093/clinchem/hvaa252
Mannu GS, Zaman MJ, Gupta A, Rehman HU, Myint PK. Evidence of lifestyle modification in the management of hypercholesterolemia. Curr Cardiol Rev. 2013;9(1):2-14. https://doi.org/10.2174/157340313805076313
Alqahtani MS, Alzibali KF, Mahdi AMM, et al. Lipid-Lowering Medications for Managing Dyslipidemia: A Narrative Review. Cureus. 2024;16(7):e65202. https://doi.org/10.7759/cureus.65202
Feingold KR. Introduction to Lipids and Lipoproteins. In: Feingold KR, Adler RA, Ahmed SF, et al., eds. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2024 [cited 2025 Dec 28]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK305896/
Real JT, Ascaso JF. Lipid metabolism and classification of hyperlipaemias. Clin Investig Arterioscler. 2021;33 Suppl 1:3-9. https://doi.org/10.1016/j.arteri.2020.12.008
Bays HE, Kirkpatrick CF, Maki KC, et al. Obesity, dyslipidemia, and cardiovascular disease: A joint expert review from the Obesity Medicine Association and the National Lipid Association 2024. J Clin Lipidol. 2024;18(3):e320-e350. https://doi.org/10.1016/j.jacl.2024.04.001
Mosteoru S, Gaiţă L, Gaiţă D. Sport as Medicine for Dyslipidemia (and Other Risk Factors). Curr Atheroscler Rep. 2023;25(9):613-617. https://doi.org/10.1007/s11883-023-01133-y
Wu SA, Kersten S, Qi L. Lipoprotein Lipase and Its Regulators: An Unfolding Story. Trends Endocrinol Metab. 2021;32(1):48-61. https://doi.org/10.1016/j.tem.2020.11.005
Yang YJ. An Overview of Current Physical Activity Recommendations in Primary Care. Korean J Fam Med. 2019;40(3):135-142. https://doi.org/10.4082/kjfm.19.0038
Castro-Barquero S, Ruiz-León AM, Sierra-Pérez M, Estruch R, Casas R. Dietary Strategies for Metabolic Syndrome: A Comprehensive Review. Nutrients. 2020;12(10):2983. https://doi.org/10.3390/nu12102983
Chopra AK. Dietary management of dyslipidemia. Indian Heart J. 2024;76(Suppl 1):S65-S72. https://doi.org/10.1016/j.ihj.2023.12.00
Chiavaroli L, Viguiliouk E, Nishi SK, et al. DASH Dietary Pattern and Cardiometabolic Outcomes: An Umbrella Review of Systematic Reviews and Meta-Analyses. Nutrients. 2019;11(2):338. https://doi.org/10.3390/nu11020338
Wang Q, Wu D, Huang Y. The integral role of lifestyle in the prevention and management of hypertension and associated cardiometabolic and cognitive disorders: a review. Front Endocrinol (Lausanne). 2025;16:1682814. https://doi.org/10.3389/fendo.2025.1682814
Trautwein EA, McKay S. The Role of Specific Components of a Plant-Based Diet in Management of Dyslipidemia and the Impact on Cardiovascular Risk. Nutrients. 2020;12(9):2671. https://doi.org/10.3390/nu12092671
Feingold KR. Triglyceride Lowering Drugs. In: Feingold KR, Adler RA, Ahmed SF, et al., eds. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2025 [cited 2025 Dec 28]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK321663/
Ye XF, Miao CY, Zhang W, Ji LN, Wang JG; ATTEND investigators. Alcohol intake and dyslipidemia in male patients with hypertension and diabetes enrolled in a China multicenter registry. J Clin Hypertens (Greenwich). 2023;25(2):183-190. https://doi.org/10.1111/jch.14638
Waśkiewicz A, Sygnowska E. Alcohol intake and cardiovascular risk factor profile in men participating in the WOBASZ study. Kardiol Pol. 2013;71(4):359-365. https://doi.org/10.5603/KP.2013.0063
Dybiec J, Baran W, Dąbek B, et al. Advances in Treatment of Dyslipidemia. Int J Mol Sci. 2023;24(17):13288. https://doi.org/10.3390/ijms241713288
Penson PE, Bruckert E, Marais D, et al. Step-by-step diagnosis and management of the nocebo/drucebo effect in statin-associated muscle symptoms patients: a position paper from the International Lipid Expert Panel (ILEP). J Cachexia Sarcopenia Muscle. 2022;13(3):1596-1622. https://doi.org/10.1002/jcsm.12960
Agnello F, Ingala S, Laterra G, Scalia L, Barbanti M. Novel and Emerging LDL-C Lowering Strategies: A New Era of Dyslipidemia Management. J Clin Med. 2024;13(5):1251. https://doi.org/10.3390/jcm13051251
Dec A, Niemiec A, Wojciechowska E, et al. Inclisiran-A Revolutionary Addition to a Cholesterol-Lowering Therapy. Int J Mol Sci. 2023;24(7):6858. https://doi.org/10.3390/ijms24076858
Ray KK, Wright RS, Kallend D, et al. Two Phase 3 Trials of Inclisiran in Patients with Elevated LDL Cholesterol. N Engl J Med. 2020;382(16):1507-1519. https://doi.org/10.1056/NEJMoa1912387
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Copyright (c) 2026 Weronika Mstowska, Ewa Byjoś, Mateusz Zbylut, Karolina Bury, Katarzyna Fabiś, Kamila Milewska, Sylwia Buczek, Patrycja Mateja, Hanna Naliuka, Katarzyna Młynarczyk

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