PhD Defense: Healthy lifestyle in secondary cardiovascular disease prevention; Dietary patterns, physical activity, and their long-term benefits

Cardiovascular disease (CVD) is the leading global cause of morbidity and mortality, contributing to 18 million deaths annually. While unhealthy lifestyle habits are key risk factors for developing CVD, pharmacological interventions often supersede lifestyle modifications once the disease becomes clinically manifest. 

In this thesis, the role of healthy dietary- and physical activity habits in managing stable CVD was explored. In two meta-analyses the relationship between different dietary patterns and cardiovascular risk factor levels was assessed in patients with diabetes and CVD. Furthermore, it was investigated how compliance with dietary patterns was associated with risk of recurrence of cardiovascular events such as myocardial infarction or stroke in CVD patients. Concurrently, the association between different types of physical activity and clinical outcomes was analysed, focussing on the biological pathways mediating these relationships.
In the final part of the thesis an integrated approach to lifestyle change is presented. The aims were to predict the lifetime benefit of adopting a healthy lifestyle even after CVD had become clinically manifest. It was demonstrated that multiple years free of recurrent cardiovascular events could be achieved through lifestyle interventions and that these interventions are highly cost-effective.

In conclusion, this thesis provides comprehensive insights into the multifaceted role of healthy dietary and physical activity habits in the clinical management of stable CVD, also after clinical manifestation. The findings support active lifestyle guidance into routine clinical care for patients with established CVD.