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Health Promotion and Disease Prevention Knowledge Gateway

A reference point for public health policy makers with reliable, independent and up-to date information on topics related to promotion of health and well-being.

Page | Last updated: 08 Apr 2021

Risk factors related to cardiovascular disease

Risk factors related to Cardiovascular Diseases as described by health-related organisations

Effect of diet on cardiovascular diseases

EFSA 2019
  • At the individual level, if the usual intake of sodium exceeds 2 g/day, it could be associated with an increased risk of cardiovascular diseases.
EFSA 2010
  • evidence from dietary intervention studies that decreasing the intakes of products rich in saturated fatty acids by replacement with products rich in n-6 polyunsaturated fatty acids (without changing total fat intake) decreases the number of cardiovascular events.

NNR 2012 (pdf)
  • '[T]here is convincing evidence that partial replacement of SFA with PUFA decreases the risk of CVD, especially in men'.
  • Dietary fibre from various foods probably protects against the development of CVD.
  • 'Sodium intake is positively associated with an increased risk of stroke and cardiovascular events and mortality among the general adult population'.
DGAC 2015
  • Strong and consistent evidence […] shows that replacing saturated fatty acids with polyunsaturated fatty acids reduces the risk of CVD events and coronary mortality.
EFSA 2010
  • '[T]here is epidemiological evidence for a protective effect of dietary fibre intake >24 g per day on cardiovascular disease risk'.

DGE 2012
  • ‘A high dietary fibre intake, mainly from whole-grain products, reduces the risk of obesity, type 2 diabetes mellitus, dyslipoproteinaemia, cardiovascular disease and colorectal cancer at varying evidence levels.’
WHO 2012 (pdf)
  • 'WHO recommends a reduction in sodium intake to reduce blood pressure and risk of cardiovascular disease, stroke and coronary heart disease in adults'.
  • 'High and moderate-quality evidence that consuming <2 g sodium/day compared with consuming ≥2 g sodium/day is beneficial for reducing blood pressure and risk of cardiovascular disease, stroke and coronary heart disease in adults'
DGE 2016 (pdf)
  • 'There are […] convincing data that high salt intake has an indirect effect on the risk of cardiovascular diseases, which is mediated by the level of blood pressure'.
  • '[A] direct association between high salt intake and the risk of cardiovascular diseases is not unambiguously clear. The evidence is disparate or even inconsistent, so that there is currently no unambiguous proof that high salt intake increases the risk of cardiovascular disease'.
WHO 2007 (pdf)
  • 'Fruits and vegetables may promote cardiovascular health through a variety of micronutrients, antioxidants, phytochemicals, flavonoids, fibre and potassium'.
DGE 2016
  • 'In all meta-analyses concerning fruit intake, there was a significant reduced risk of cardiovascular diseases. This applies to both endpoints – coronary heart disease and stroke'.
DGAC 2015
  • 'Strong and consistent evidence demonstrates that dietary patterns associated with decreased risk of CVD are characterized by higher consumption of vegetables, fruits, whole grains, low-fat dairy, and seafood, and lower consumption of red and processed meat, and lower intakes of refined grains, and sugar-sweetened foods and beverages relative to less healthy patterns'.
  • 'Regular consumption of nuts and legumes […] are shown to be components of a beneficial dietary pattern in most studies. Randomized dietary intervention studies have demonstrated that healthy dietary patterns exert clinically meaningful impact on cardiovascular risk factors, including blood lipids and blood pressure'.
SACN 2015
  • 'No significant association is observed between sugars consumption and incidence of coronary events […]'
  • 'There is […] insufficient evidence to assess the link between individual sugars and sugars-sweetened foods and beverages and cardio-metabolic outcomes'.
DGAC 2015
  • 'Moderate evidence […] indicates that higher intake of added sugars, especially in the form of sugar sweetened beverages, is consistently associated with increased risk of hypertension, stroke, and CHD in adults'.
NNR 2012 (pdf)
  • There is moderate evidence that whole grains are associated with protection against cardiovascular disease.
SACN 2015
  • '[A] diet rich in dietary fibre (mostly defined as AOAC) reduces the risk of type 2 diabetes mellitus, cardiovascular disease and colo-rectal cancer […]. Despite inconsistency between studies in the definitions of whole grains, greater consumption of whole grains is associated with a lower incidence of cardiovascular disease[…].'
  • There is moderate evidence that there is an adverse relationship between higher consumption of whole grains and cardiovascular disease.
DGAC 2015
  • Some evidence indicates that whole grain intake may reduce the risk for cardiovascular diseases.

Effect of physical (in)activity on cardiovascular diseases

EU Physical Activity Guidelines 2008 (pdf)
  • Physical activity is associated with prevention of cardiovascular disease.
World Health Organization 2018 (pdf)
  • 'Insufficient physical activity is a key risk factor for CVD'
  • Regular and adequate levels of physical activity help to reduce the risk of hypertension, heart attack, stroke.
European Society of Cardiology 2016 (pdf)
  • Regular physical activity is a mainstay of cardiovascular disease prevention; participation decreases all-cause and cardiovascular mortality.
Health Council of the Netherlands 2017 (pdf)
  • In adults and older persons, physical activity reduces the risk of cardiovascular disease.
UK-Chief Medical Officers report 2011 (pdf)
  • There is strong evidence that physical activity results in a 20-35% lower risk of cardiovascular disease, coronary heart disease and stroke.
Physical Activity Guidelines for Americans Advisory Committee 2018
  • 'Strong evidence demonstrates a significant relationship between greater amounts of physical activity and decreased incidence of cardiovascular disease, stroke and heart failure'. There is insufficient evidence to determine whether this relationship varies by age, sex, race, ethnicity, socioeconomic status, or weight status.
  • 'There is no lower limit for the relation of moderate-to-vigorous physical ac tivity and risk reduction. Risk appears to continue to decrease with increased exposure up to at least five times the current recommended levels of moderate-to-vigorous physical activity.'
  • 'Strong evidence demonstrates the existence of a direct, positive dose-response relationship between sedentary behavior and mortality from cardiovascular disease.’ There is insufficient evidence to determine whether this relationship varies by age, sex, race, ethnicity, socioeconomic status, or weight status.
  • 'Strong evidence demonstrates the existence of a direct, graded dose-response relationship between sedentary behavior and risk of incident cardiovascular disease.'
  • 'Strong evidence demonstrates that a strong inverse dose-response relation exists between amount of moderate-to-vigorous physical activity and cardiovascular disease mortality'. Strong evidence demonstrates that this relationship does not vary by age, sex, race, or weight status.
American College of Sports Medicine 2011
  • '[E]nergy expenditure of approximately 1000 kcal/week of moderate-intensity physical activity (or about 150 min/week) is associated with lower rates of CVD and premature mortality'.


Effect of smoking on cardiovascular disease

WHO 2019 (pdf)
  • Tobacco use significantly increases the probability of dying prematurely from several NCD causes of death accounting for 25% of CVD deaths in men and 6% CVD deaths in women.
  • CVD (particularly heart attacks and stroke) are often fatal events among men who smoke.
WHO 2012
  • Tobacco use and secondhand smoke exposure are major causes of cardiovascular disease, contributing to approximately 10% of all cardiovascular deaths globally.
ESC 2012 (pdf)
  • Smoking is an established cause of a plethora of diseases and is responsible for 50% of all avoidable deaths in smokers, half of these due to CVD.
  • Smoking is associated with increased risk of all types of CVD.
  • Changing smoking behaviour is a cornerstone of improved CVD health.
U.S. Department of Health and Human Services Surgeon General Report 2010 and 2014
  • There is an extensive body of evidence showing that smoking tobacco is causally related to almost all major forms of CVD.
  • 'Low levels of exposure, including exposures to secondhand tobacco smoke, lead to rapid and sharp increase in endothelial dysfunction and inflammation, which are implicated in acute cardiovascular events and thrombosis'.
  • '[E]xposure to secondhand smoke causes an increased risk of stroke'.
American Heart Association 2018
  • There is a sharp increase in CVD risk with low levels of exposure to cigarette smoke, including secondhand smoke, and a less rapid further increase in risk as the number of cigarettes per day increases.



Effect of alcohol consumption on cardiovascular diseases

World Health Organization 2014 (pdf)  
  • The highest numbers of alcohol-attributable deaths are from cardiovascular diseases.
  • Heavy episodic pattern of drinking 'has been linked to injuries and risk of cardiovascular diseases (mainly ischaemic heart disease and ischaemic stroke)'.
European Society of Cardiology 2016  
  • 'Excessive alcohol intake is associated with increased CV mortality'.
  • At the population level, alcohol consumption is associated with mulptiple health risks that clearly outweigh any potential benefits.
NNR 2012 (pdf)  
  • Alcohol has been associated with cardiovascular diseases such as coronary heart disease (CHD), atrial fibrillation (AF), ischemic stroke, haemorrhagic stroke and congestive heart failure (CHF).
NIAAA 2015  
  • Long-term heavy drinking causes weakening of the heart muscle, called alcoholic cardiomyopathy, which can lead to heart failure.
  • Both binge drinking and long-term drinking can cause arrhythmias.


Effect of environment and pollution related factors on cardiovascular diseases

WHO 2019
  • 'Ambient air pollution is currently the greatest environmental risk to health, causing mainly cardiovascular and respiratory diseases'.
WHO 2016
  • 'Fine particulate matter penetrates through the lungs into the bloodstream causing both respiratory and cardiovascular impacts'.
WHO 2005
  • Health effects of air pollution include cardiovascular hospital admissions, cardiovascular primary care visits, use of cardiovascular medication and chronic cardiovascular disease.
ESC 2020
  • There is strong evidence suggesting that chronic and persistent exposure to air pollution increases the progression of atherosclerotic lesion and has adverse effects on blood pressure regulation, peripheral thrombosis, endothelial function and insulin sensitivity.
WHO, JRC 2011 (pdf)
  • Road traffic noise has been shown to increase the risk of ischaemic heart disease, including myocardial infarction. Both road traffic noise and aircraft noise increase the risk of high blood pressure.
  • Epidemiological studies suggest a higher risk of cardiovascular diseases, including high blood pressure and myocardial infarction, in people chronically exposed to high levels of road or air traffic noise
WHO 2003 (pdf)
  • In adults, relatively low levels of lead exposure (5 µg/dl) may increase blood pressure, which can then lead to cardiovascular diseases.