Lifestyle Medicine and Cardiovascular Health: A Concept Whose Time has Come

“Cardiovascular disease remains the leading cause of mortality in the United States and around the world.”

This issue of the American Journal of Lifestyle Medicine (AJLM) is the first Special Issue we have published devoted to 1 clinical topic. In this case, cardiovascular health. I hope and anticipate that there will be many more Special Issues in various academic disciplines as the field of lifestyle medicine continues to grow and expand and assume its rightful place in mainstream medicine.

For many reasons, it seems particularly fitting that our first Special Issue of AJLM is devoted to cardiovascular health. First, as a cardiologist and researcher in lifestyle medicine, I believe in the enormous synergy between the fields. Secondly, few academic disciplines have been as closely aligned with lifestyle medicine as cardiology.

I would emphasize, however, that many other disciplines such as family practice, preventive medicine, occupational health, psychiatry and pediatrics just to name a few, have also embraced the concept of lifestyle medicine in relationship to their specific fields.

With regard to cardiovascular medicine, in 2013 the American Heart Association (AHA) changed the name of one of its academic councils from the “Council on Nutrition, Physical Activity and Metabolism” to the “Council on Lifestyle and Cardiometabolic Health.” ¹ That same year, the AHA and the American College of Cardiology issued “Guidelines for Lifestyle Management to Reduce Cardiovascular Risk.” ² Positive lifestyle is also listed as the leading therapeutic factor in the joint recommendations for blood pressure control ³ and lipid management ⁴ from both the AHA and ACC.

In addition, the AHA listed in its 2020 strategic plan an expanded purview for the future for the organization to fully embrace “cardiovascular health” in addition to reducing cardiac risk factors and treating cardiovascular disease. ⁵ The AHA articulated the simple strategy to emphasize lifestyle factors by developing the mantra “Life’s Simple Seven” to emphasize how various lifestyle factors and measurements contribute to cardiovascular health. The 2020 strategic plan emphasized that cardiovascular health was a broad concept. The AHA makes the important point that avoiding risk factors in the first place leads to further enhancement of cardiovascular health. The AHA expanded the purview of the cardiovascular health concept in 2022 and fine-tuned it by adding sleep as the eighth cardiovascular health parameter and changed the mantra to “Life’s Essential 8.” ⁶

In addition, over the last few years, important milestones in cardiovascular health and lifestyle medicine have occurred. For example, in 2024, marked the 25th anniversary of my eponymous, multi-authored academic textbook, Lifestyle Medicine. ⁷ The first edition of this textbook published in 1999 named the field of lifestyle medicine in the academic literature. ⁸ The year 2024 also heralded the publication of the fourth edition of this comprehensive textbook which spans the field of lifestyle medicine. Also, in 2024, the American College of Lifestyle Medicine, which has been a powerful force leading the field of lifestyle medicine, celebrated its 20th anniversary. ⁹ ACLM membership now exceeds 13 000, which makes it the fastest growing medical organization in the world. Finally, 2026 represents the 20th anniversary of the founding of the American Journal of Lifestyle Medicine. ¹⁰ What started as a vision in AJLM to provide a forum for academic articles on the interface between daily habits and actions and short and long-term health has now grown to 23 000 subscribers and last year experienced over 344 000 downloads of full academic texts.

While we in the lifestyle medicine community have much to be proud of, the task is by no means completed. Cardiovascular disease remains the leading cause of mortality in the United States and around the world. Indeed, in third world countries the percentage of mortality associated with cardiovascular disease has grown from 26% to 32% in the past decade. In the United States, 37% of all mortality results from cardiovascular disease. Even though cardiovascular health has become a new and important strategic imperative for the AHA, less than 1% of individuals have adopted the complete array of factors in “Life’s Essential 8.” ⁶

Adoption of these factors is what the AHA lists as required for “ideal” cardiovascular health. Around the world the WHO initiative to combat non-communicable diseases has stated that 74% of all mortality comes from daily habits and practices. ¹¹ Thus, while great progress has been achieved, enormous challenges remain.

The current Special Issue of AJLM explores a variety of factors concerning how lifestyle habits impact on cardiovascular health. The important article by Reddy and colleagues demonstrates that lifestyle habits and practices significantly reduce the likelihood of morbidity and mortality from the COVID-19 pandemic. ¹² The article by Meizah and Hayman reminds us that high blood pressure is present in over 1 billion individuals all over the world and that it is imperative to adopt culturally tailored treatments in order to combat this leading risk factor for heart disease. ¹³

Leal et al and Moxley et al both show that lifestyle factors interact with each other.^14,15 Leal points out that individuals who were depressed were less likely to be physically active and are less likely to experience healthy sleep. Moxley showed in an acute research study that cardiovascular fitness was strongly associated with body fat and risk factors for diabetes. ¹⁵ Alyahya et al ¹⁶ and Sharma et al ¹⁷ extend lifestyle medicine concepts to hypertrophic obstructive cardiomyopathy and arthritis which expand the areas where lifestyle medicine practices can have a significant impact.

Unfortunately, as the article from Krachler et al points out individuals who are at the highest risk for cardiovascular disease are also at the greatest risk of dropping out of lifestyle medicine programs. ¹⁸ On a positive note, the article by Yiaslas et al shows that a 15 week whole food, plant-based diet can substantially reduce risk factors for both heart disease and diabetes. ¹⁹ While Toole et al show that psychological services can be integrated in a very positive way through a preventive cardiology consult program. ²⁰

The article by Sun, Feng, and Hu describes an important initiative undertaken at the Fuwai Hospital in China. ²¹ The Fuwai Hospital is the largest cardiovascular hospital in the world. Dr Feng is a high level cardiologist who provides the leadership for the establishment of China’s first Center for Healthy Lifestyle Medicine CLM). The senior author of this article, Dr Shengshou Hu, is not only the CEO of the Fuwai Hospital, but also a member of the Chinese Academy of Medical Sciences and the Peking Union Medical College. Dr Hu’s support has been critically important in establishing the Center for Lifestyle Medicine in China. This is the first Center for Lifestyle Medicine at a tertiary care hospital in China. It is hoped that there will be many more in the future. This article does an impressive job of linking the modern understandings of lifestyle medicine to history of lifestyle practices in China. This article is a worthwhile read for everyone to understand how the field of lifestyle medicine has advanced throughout the world, and, in particular, into one of the largest economies in the world. It will be critically important as lifestyle medicine moves forward to recognize that the cultural differences in various countries will need to be embraced in order for lifestyle medicine to prosper and exert a positive impact on the health of people in diverse countries.

I was honored to participate as a consultant for the establishment of this initiative in China. This relationship started when Fuwai Hospital purchased the Chinese translation rights for the third edition of my Lifestyle Medicine textbook. ²²

The level of interest in lifestyle medicine China is astounding! I was pleased to participate in their third annual Lifestyle Medicine conference which was attended virtually by over 2.5 million people. A subsequent conference and research symposium linking lifestyle medicine to cardiovascular health was attended by even higher number of individuals with 2.8 million people participating either in person or virtually. ²³

Finally, I have contributed a state of the art review to this Special Issue of AJLM entitled “Lifestyle Medicine and Cardiovascular Health” which further articulates and summarizes the synergy between these 2 disciplines. ²⁴

This Special Issue of Lifestyle Medicine and Cardiovascular Health in AJLM underscores the ferment in the lifestyle medicine community and how these 2 disciplines impact on each other. I am particularly pleased at the diversity of these articles and also the fact that articles came from countries around the world including the United States, Sweden, China and the United Kingdom.

As this Special Issue illustrates, there is great worldwide interest and progress on the relationship between lifestyle medicine and cardiovascular health. While we can feel proud of the significant progress that has been made it is important not to rest on our laurels. Numerous challenges lie ahead, but we are off to a good start! As the American poet Robert Frost articulated in his famous poem Stopping by Woods in the Snowy Evening, we have “miles to go before we sleep.” ²⁵